组织多普勒成像评价静息冠心病患者心脏局部功能

Evaluation of regional cardiac function for patients with coronary heart disease by tissue Doppler imaging in rest state

目的在静息状态下应用组织多普勒成像（TDI）的多种测量指标评价冠心病患者的心脏局部功能，并探讨心脏局部功能测定在冠心病诊断中的价值。方法对47例主诉胸痛的住院患者进行TDI检查，测定左室16个节段的收缩峰速度（Sm）、舒张早期峰速度（Em）、舒张晚期峰速度（Am）、等容收缩时间（IVCT）和等容舒张时间（IVRT）。所有患者同时行冠状动脉造影检查，有至少1支直径狭窄≥50％的冠状动脉则诊断冠心病。规定直径狭窄≥50％且〈90％的冠状动脉支配节段为轻度病变节段，直径狭窄I〉90％的冠状动脉支配节段为重度病变节段，其余节段为非病变节段。结果非冠心病（13例）、1支病变（11例）、2支病变（11例）以及3支病变（12例）患者性别构成、年龄、心率、冠心病易患因素、左室射血分数及跨二尖瓣舒张早期血流速度与舒张晚期血流速度比值（E／A）比较差异均无统计学意义（P〉0．05）。与非病变节段（390个）比较，轻度病变节段（162个）和重度病变节段（144个）的Sm、Em、Em／Am明显下降（P〈0．01），IVRT明显延长（P〈0．01），轻度病变节段IVCT与非病变节段比较差异无统计学意义（P〉0．05），但重度病变节段IVCT显著延长（P〈0．05）。如果以至少存在3个节段的Sm〈2．50cm／s且IVRT〉87ms作为诊断冠心病的标准，则该标准诊断冠心病的敏感度为79．4％（27，34），特异度为84．6％（11／13），阳性预测值为93．1％（27／29），阴性预测值为61．1％（11／18），准确度为80．9％（38／47）。结论静息状态下，冠心病患者病变部位的心脏局部功能变化体现在收缩和舒张运动速度的下降和等容运动时间的延长，综合分析心脏节段运动速度和运动时间有助于冠心病的诊断。

Objective To evaluate the regional cardiac function for patients with coronary heart disease （CHD） with multiple tissue Doppler imaging （TDI） parameters in rest state and to discuss the value of regional eardiae funetion in diagnosing CHD. Methods Forty-seven patients with ehief complain of chest pain underwent TDI examination. Maximum systolic velocity （Sm）, maximum early diastolic velocity （Era）, maximum late diastolic velocity （Am）, isovoluminal contraction time （IVCT） and isovoluminal relaxation time（IVRT） of 16 segments of left ventricle were measured. All the patients underwent coronary angiography （CAG） at the same time. CHD was diagnosed by at least one coronary artery with no less than fifty percent diametric stenosis. Segments dominated by coronary artery with fifty to ninety and more than ninety percent diametric stenosis were defined as moderate and severe lesion segments respectively. Others were non-lesion segments, Results There was no significant difference of sex,age,heart rate,CHD risk factors,left ventricular ejection fraction （LVEF） and E/A among non-CHD（ 13 cases ）, one-lesion （ 11 cases ）, two-lesion （11 cases） and three-lesion （12 cases）（P 〉0.05）. Compared with those in non-lesion segments （390 sections）, Sm, Em and Em/Am decreased and IVRT prolonged in both moderate lesion segments （162 sections） and severe lesion segments （144 sections）（P 〈 0.01）. IVCT prolonged only in severe lesion segments （P 〈 0.05）,but not in moderate lesion segments. If setting a criterion that no less than three segments with Sm 〈 2.50 cm/s and IVRT 〉 87 ms was for CHD diagnosis, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 79.4% （27/34）, 84.6% （ 11/13）＇,93.1% （27/29） ,61.1%（11/18） and 80.9%（38/47）. Conclusions In rest state,regional cardiac function of lesion segments in CHD patients shows changes of decreased systolic and diastolic velocity and prolonged isovoluminal time. Analyzing segmental cardiac velocity and time comprehensively may help to diagnose CHD.