二维超声结合脉冲组织多普勒成像对婴幼儿心内膜弹力纤维增生症的诊断价值

Diagnosis Value of Two-Dimension Echocardiography Combined with Pulsed-Wave Tissue Doppler Imaging in Children with Endocardial Fibroelastosis

目的:探讨二维超声结合脉冲组织多普勒成像(PW-TDI)在评价婴幼儿心内膜弹力纤维增生症(EFE)中的价值。方法:心内膜弹力纤维增生症组(EFE组)和正常对照组各31例。应用常规二维超声观察心室壁运动的幅度及心内膜回声强度变化,同时获取以下指标:左室舒张末期前后径(LVED),左房舒张末期前后径(LAED),心内膜厚度,左室射血分数(LVEF),左室短轴缩短率(LVFS),二尖瓣舒张早期峰值流速(E)、舒张晚期峰值流速(A)及等容舒张时间(IVRT)。应用脉冲组织多普勒获取心尖四腔切面二尖瓣环侧壁缘收缩期峰值运动速度(Vs),二尖瓣环舒张早期峰值运动速度(Ve),舒张晚期峰值运动速度(Va)及舒张早晚期速度比值(Ve/Va)。结果:EFE患儿心内膜增厚、回声增强,室壁运动幅度明显减低;LVED、LAED及IVRT不同程度增大,LVEF、LVFS、E、Ve及Va明显减低,与对照组比较差异有统计学意义(P<0.05);A峰呈下降趋势,Ve/Va变化不明显,与对照组比较差异无统计学意义(P>0.05)。结论:二维超声心动图能客观显示EFE心腔大小变化,心内膜厚度及瓣膜室壁活动情况,PW-TDI可较准确反映左室的收缩及舒张功能变化,两者结合应用评价EFE较可靠。

Objective： To investigate the value of two-dimension echocardiography combined with pulsed-wave tissue Doppler imaging （PW-TDI） in the diagnosis of child endocardial fibroelastosis （EFE）. Methods. Thirty-one cases with EFE and 31 normal children were enrolled in this study. The amplitude of ventrieular wall motion and the echo change of endocardium were observed by conventional echocardiography. We measured the following indicators as left ventricle end dias- tolic diameter （LVED）, left atrial end diastolic diameter （LAED）, endocardium thickness, left ventricular ejection fraction （LVEF）, left ventricular fractional shorting （LVFS）, mitral early diastolic peak velocity （E）, late diastolic peak velocity （A）, and isovolumic relaxation time （IVRT）. Of the lateral site of mitral annulus on apical four-chamber view by pulsed-wave Doppler tissue imaging, TDI parameters including systolic peak velocity （Vs）, early and late di- astolic peak velocity （Ve and Va）, and the ratio of the early/late diastolic velocity（Ve/Va） were obtained and compared between the two groups. Results： Compared with normal control, chil- dren with EFE had thickened and hyperechoic endocardium obviously. Ventricular wall motion amplitude obviously reduced in EFE group. The LVED, LAED, and IVRT were significantly in- creased, while LVEF, LVFS, E, Ve, and Va were decreased （P〈0. 05） in the EFE group. Conclusion： Two-dimensional echocardiography can objectively reveal the change of atrioventricular cavity, endocardium thickness, valve and ventricular wall motion of EFE. PW-TDI can accu- rately evaluate the systole and diastolic function of left ventricular. The application of both meth- ods is more reliable in the diagnosis of EFE.