双脉冲多普勒超声心动图技术测量T_(E-e’)评估冠心病患者左心室舒张功能

Evaluation of left ventricular diastolic function by T_(E-e') measurement using dual Doppler echocardiography in coronary heart disease patients with preserved systolic function

目的探讨双脉冲多普勒超声心动图技术测量舒张早期二尖瓣血流E波开始时间与舒张早期二尖瓣瓣环e’波开始时间差值TE-e’,评估TE-e’诊断左心室舒张功能不全准确性。方法连续入组冠心病患者77例,所有患者均行冠脉造影,心导管测量左心室舒张末压力(LVEDP);双脉冲多普勒技术测量舒张早期二尖瓣血流峰值速度E与舒张早期二尖瓣瓣环峰值速度e’,计算E/e’与TE-e’,评估左心室舒张末压力与TE-e’相关性及E/e’、TE-e’与TE-e’联合E/e’,诊断左心室舒张末功能不全[指左心室舒张末期压力≥12 mmHg(1 mmHg=0.133 kPa)]的准确性。结果 1、左心室舒张末压(LVEDP)与TE-e’,E/e’相关性分别为r=0.42和r=0.79,P<0.001;2、TE-e’≥38 ms时,诊断左心室舒张功能不全的敏感性为54%,特异性为79%,ROC曲线下面积0.71。E/e’≥9.2时,诊断左心室舒张功能不全敏感性为74%,特异性为81%,ROC曲线下面积0.87;3、联合E/e’≥9.2,TE-e’≥38 ms诊断左心室舒张功能不全敏感性为100%,特异性为62%,ROC曲线下面积0.96。结论双脉冲多普勒技术测量TE-e’为评估左心室舒张功能不全的有效指标,联合E/e’能够提高诊断左心室舒张功能不全的准确性。

Objective To evaluate the accuracy of the time interval between the onset of early transmitral flow velocity （E） and that of early diastolic mitral annular velocity （e＆#39;） （TE- e＆#39;） measured by dual Doppler echocardiography in the diagnosis of diastolic dysfunction. Methods Seventy-seven coronary heart disease patients with preserved systolic function underwent a echocardiographic study. Early transmitral flow velocity E and early diastolic mitral annular velocity e＆#39; were simultaneously recorded by dual Doppler echocardiography. The E/e＆#39; and TE-e＆#39; were calculated and compared with the left ventricular end diastolic pressure （LVEDP）, which was measured invasively. The validity of TE-e＆#39;, E/e＆#39; and their combination was analyzed in estimating left ventricular dysfunction （LVEDP ≥12 mmHg）. Results The single-beat E/e＆#39; and TE-e＆#39; were correlated with the LVEDP （r=0.79 and 0.42, respectively, P＆lt;0.001）. Receiver-operating characteristic analysis showed that the optimal cut-off for TE-e＆#39; was 38 ms （sensitivity 54%, specificity 79%, AUC 0.71） and that for E/e＆#39; was 9.2 （sensitivity 74%, specificity 81%, AUC 0.87） for diagnosis of left ventricular diastolic dysfunction. The combined cut-offs of TE-e＆#39;≥38 ms and E/e＆#39;≥9.2 had a sensitivity of 100%and a specificity of 62%in diagnosing left ventricular diastolic dysfunction with an AUC of 0.96. Conclusion In patients with coronary heart disease, the simultaneous recording of TE-e＆#39; by dual Doppler echocardiography can accurately estimate diastolic dysfunction, and its combination with E/e＆#39; can further improve the diagnostic accuracy.