组织多普勒技术对舒张性心力衰竭患者药物负荷前后左室舒张功能的评价

Evaluation of left ventricular diastolic function in patients with diastolic heart failure by stress esmolol tissue Doppler imaging

目的 探讨组织多普勒显像 (TDI)在药物负荷前后对左室舒张功能的评价。方法 采用TDI 心导管同步血流动力学技术测量静脉注射艾司洛尔前后合并舒张性心力衰竭的肥厚型心肌病 (HCM )患者的二尖瓣和肺静脉血流频谱、TDI频谱及左室舒张末压 ,并与正常组进行比较。结果 二尖瓣血流频谱舒张早期E波最大流速和TDI技术测定的舒张早期TDI速度峰值的比值与左室舒张末压显著相关 ;与正常组相比 ,HCM患者收缩期TDI速度峰值差异无显著性意义 ,舒张早期TDI速度峰值显著减低 ,舒张晚期TDI速度峰值显著增高 ,舒张早期与舒张晚期TDI速度峰值的比值显著减低 ;静脉注射艾司洛尔后 ,HCM患者收缩期和舒张早期TDI速度峰值无显著性变化 ,舒张晚期TDI速度峰值显著降低 ,舒张早期与舒张晚期TDI速度峰值的比值略升高。结论 二尖瓣血流频谱舒张早期E波最大流速和TDI技术测定的舒张早期TDI速度峰值的比值与左室舒张末压显著相关 ,TDI技术对评价药物负荷前后舒张性心力衰竭患者的左室舒张功能具有重要的临床应用价值。

Objective To detect left ventricular function in patients with diastolic heart failure (DHF) before and after esmolol administration by tissue Doppler imaging(TDI).Methods Left ventricular diastolic function in patients with DHF were studied using TDI, pulsed Doppler echocardiography and catheterization before and after esmolol administration.Results The ratios of E velocity measured by Doppler mitral flow and peak myocardial velocity of the early diastolic wave measured by TDI technique were correlated well with left ventricular end diastolic pressure (r= 0.63 , 0.80 , 0.64 , 0.81 , respectively). Comparing with controls,myocardial segments in patients with DHF had lower peak velocity of the early diastolic wave (Em), higher peak velocity of the late diastolic wave (Am) and decreased Em/Am ratio. There was no difference in systolic myocardial velocity between two groups. Indeed, in the present study Doppler echocardiography identified abnormalities in 6 ( 35.29 %) of 17 patients compared with 13 ( 76.48 %) of 17 patients identified by TDI. After esmolol administration, S wave velocity of pulmonary venous flow was decreased and the peak of retrograde velocity at atrial contraction and its duration was also lowered. But other indices of pulmonary venous flow and parameters of mitral flow were unchanged during infusion esmolol. Peak myocardial velocity of the late diastolic wave significantly was decreased after esmolol administration, but there were no change in the peak myocardial velocity of the late diastolic wave and the Em/Am ratio.Conclusions The ratios of E velocity measured by Doppler mitral flow and peak myocardial velocity of the early diastolic wave measured by TDI technique offer new noninvasive parameters in evaluation left ventricular end diastolic pressure. TDI techniques are more useful noninvasive modalities for the early recognition of improvement in left ventricular diastolic dysfunction.