双脉冲多普勒超声心动图技术测量E/e＇评价冠心病患者左心室舒张功能

Evaluations of diastolic functions with E/e＇ obtained by dual-Doppler simultaneous recording of flow and tissue Doppler velocities in coronary heart disease patients with preserved systolic function

目的 运用双脉冲多普勒超声心动图技术测量同一心动周期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’比值,评估E/e＇双脉冲多普勒法诊断冠心病患者左心室舒张功能不全准确性.方法 连续入组解放军总医院2012年7至10月疑似冠心病或既往有冠心病患者77例,患者均行冠脉造影,心导管测量左心室舒张末压力（LVEDP）,检测血浆NT-proBNP水平.对比常规超声心动图法和双脉冲多普勒法测量E/e’,诊断左心室舒张功能不全[指左心室舒张末期压力≥12 mmHg（1 mmHg=0.133 kPa）]的准确性与NT-proBNP相关性.评估联合E/e’双脉冲多普勒法与NT-proBNP诊断左心室舒张功能不全的准确性.结果 （1）E/e’双脉冲多普勒法与LVEDP、logNT-proBNP相关性分别为r =0.79,r =0.47,P＜0.01.（2） E/e’常规方法与LVEDP,logNT-proBNP相关性分别r=0.61,P＜0.01;r =0.35,P＜0.05.（3）当E/e’双脉冲多普勒法≥9.2时,诊断舒张功能不全的灵敏度为74％,特异度为81％.E/e’双脉冲多普勒法与E/e’常规方法诊断舒张功能不全受试者工作特征（ROC）曲线下面积分别为0.87与0.82.NT-proBNP≥108 ng/L,诊断舒张功能不全灵敏度为69％,特异度为86％.ROC曲线下面积0.79.（4）联合E/e ＇双脉冲多普勒法≥9.2及NT-proBNP≥108 ng/L诊断左心室舒张功能不全的灵敏度86％,特异度为69％.ROC曲线下面积0.89.结论E/e’双脉冲多普勒法为诊断左心室舒张功能不全的有效指标,准确性高于E/e’常规方法,联合E/e’双脉冲多普勒法与NT-proBNP,能够提高诊断左心室舒张功能不全的准确性.

Objective To evaluate the usefulness of ratio of early diastolic transmitral flow velocity （E） to mitral annular velocity （e＇） calculated by simultaneously recording E and e＇ in coronary heart disease （CHD） patients.Methods A total of 77 CHD patients with preserved systolic functions underwent echocardiography.Left ventricular catheterization was performed to measure left ventricular end diastolic pressure （LVEDP）.The accuracy of E/e＇ was compared by recording the dual-Doppler and conventional methods for diagnosing diastolic dysfunction and the relationships between N-terminal pro-brain natriuretic peptide （NT-proBNP）.The validity of E/e＇dual Doppler and combined E/e＇dual Doppler and NT-proBNP in estimating left ventricular diastolic dysfunction namely LVEDP ≥ 12 mmHg （1 mmHg =0.133 kPa） were estimated.Results E/e＇dual Doppler was correlated with left ventricular end diastolic pressure （LVEDP） and logNT-proBNP （r =0.79,r =0.47,respectively,P 〈0.01）.E/e＇conventional was correlated with LVEDP and logNT-proBNP （r =0.61,P 〈 0.01,r =0.35,P 〈 0.05,respectively）.The area under curve （AUC） of E/e＇dual Doppler and E/e＇conventional was 0.87 and 0.82.The optimal cut-off of E/e＇dual Doppler was 9.2 with a sensitivity of 74% and a specificity of 81%.And the optimal cut-off of plasma NT-proBNP was 108 ng/L with a sensitivity of 69% and a specificity of 86%,AUC 0.79.When E/e＇dual Doppler ≥9.2 and NT-proBNP ≥ 108 ng/L were combined,the sensitivity and specificity for diagnosing diastolic dysfunction were 86% and 69%,AUC 0.89.Conclusion The accuracy of E/e＇dual Doppler is better than E/e＇conventional for diagnosing left diastolic dysfunction.When E/e＇dual Doppler and NT-proBNP are combined,it improves the evaluation accuracy of left diastolic dysfunction.