应用斑点成像及组织多普勒估测左室充盈压

Research on the Prediction of LV Filling Pressure by Speckle Tracking and Tissue Doppler Imaging

目的：二尖瓣瓣环早期血流速度与组织多普勒（tissue doppler imaging,TDI）技术测量的二尖瓣环舒张早期速度的比值和肺动脉楔压（pulmonary capillary wedge pressure,PCWP）之间的相关性已被广泛应用于心脏各种状态的研究。本研究旨在探讨二维斑点成像（speckle tissue imaging,STI）技术左室整体应变率指标E/E＇及组织多普勒技术在估测心衰患者左室充盈压方面的应用价值。方法：选择47例2010年3月~2012年10月于我院ICU证实为心衰的患者为研究对象,同时行超声检查及肺动脉楔压测量,依此分组为PCWP升高组（n=32）和PCWP正常组（n=15）,并设立年龄匹配的正常对照组（n=33）,记录二维斑点追踪技术指标和组织多普勒技术指标以及常规超声指标。结果：由STI技术测得的E/E＇VEL-ST和E/E＇SR-ST与PCWP有显著相关性,TDI技术测得的E/E＇VEL-TD仅显示弱相关性。与对照组相比,PCWP升高的患者各变量值均有显著升高。结论：STI技术指标（E/E＇SR-ST）是估测左室充盈压升高的强有力且无创的替代指标。在ICU患者中,E/E＇SR-ST显示出与PCWP更好的相关性,比TDI的技术指标更精准。

Objective： The ratio of early transmitral velocity to tissue Doppler mitral annular early diastolic velocity（E/Ea） has been correlated with pulmonary capillary wedge pressure（PCWP） in a wide variety of cardiac conditions.The objective of this study was to assess the clinical value of speckle tracking imaging（STI） and tissue doppler imaging（TDI） in detecting E/E＇ in the prediction of left ventricular filling pressure with advanced heart failure.Methods： 47 ICU patients in our hospital from March 2010 to October 2012 with decompensated heart failure were undergoing echocardiography and PCWP measurements.Patients with elevated PCWP（n=32） were compared with patients with normal PCWP（n=15）,as well as age-matched healthy controls.（n=33）.E/E＇SR-ST and E/E＇VEL-ST by STI and E/E＇VEL-TD by TDI and the paraments of the conventional Echocardiography were examined.Results： Correlations with PCWP were observed for speckle tracking derived E/E＇VEL-ST and E/E＇SR-ST,although the traditional E/E＇VEL-TD did not show a significant correlation.Compared with controls,patients with elevated PCWP had significant increases in all variables.Conclusion： E/E＇SR-ST detecked by Speckle tracking may be a robust surrogate marker of elevated LV filling pressure.In ICU,E/E＇SR-ST showed better correlation with PCWP and higher diagnostic accuracy than the tissue Doppler approach.