双通道多普勒成像技术评价心力衰竭患者左心室舒张功能

Assessment on left ventricular diastolic function in patients with heart failure using dual Doppler modality

目的探讨双通道多普勒成像技术同步测量舒张早期二尖瓣血流速度峰值与彩色M型血流传播速度比值(E/Vp)评价心力衰竭患者左心室舒张功能不全的价值。方法随机选取心力衰竭患者60例为病例组,选性别、年龄相匹配的60名健康人为对照组,采用双通道多普勒成像技术以及常规超声分别测量二尖瓣口血流舒张早期二尖瓣血流峰值速度(E峰)、舒张晚期二尖瓣血流峰值速度(A峰),组织多普勒舒张早期二尖瓣瓣环峰值速度(Em)、二尖瓣环舒张晚期运动峰值流速(Am),以及M型血流传播速度(Vp),计算同步与非同步E/Vp、E/Em。分析:1E/Vp、E/Em与纽约心脏病学会心功能分级(NYHA分级)的相关关系;2E/Vp、E/Em与N端B型利钠肽原(NT-proBNP)的相关关系;3分析E/Vp、E/Em用于左心室舒张功能评价的可行性。结果 1病例组同步及非同步测得E/Vp、E/Em高于对照组,差异有统计学意义(P均<0.01);2随着NYHA分级的增高,心力衰竭患者的同步E/Vp也随之增高,同步E/Vp与NT-proB-NP相关性良好(r=0.77,P<0.01);3当同步E/Vp≥1.32时,诊断左心室舒张功能不全的ROC曲线下面积为0.90,敏感度为74%,特异度为96%;同步E/Em≥9.11时,诊断左心室舒张功能不全的ROC曲线下面积为0.85,敏感度为61%,特异度为92%。结论采用双通道多普勒成像技术测量的同步E/Vp重复性好,能较准确地评估心力衰竭患者的左心室舒张功能。

Objective To explore the clinical value of the ratio of early diastolic mitral inflow velocity to color M-mode Doppler flow propagation velocity（E/Vp）measured by dual Doppler modality simultaneously in assessing left ventricular（LV）diastolic function in patients with heart failure.Methods Sixty patients with heart failure were selected randomly,and sixty age and sex-adjusted normal volunteers served as control group.The spectrum of the mitral valve flow and mitral annular in left ventriculai latel wall were acquired in apical four chamber view by dual Doppler modality in both groups.Mitral inflow velocity（E,A）and TDI-derived diastolic mitral annular velocuty（Em,Am）and color M-mode Doppler flow propagation velocity were measured,the E/Vp and E/Em were calculated.Analyses included：①The relationship of E/Vp,E/Em and New York Heart Association classification of cardiac function（NYHA grade）,②The relationship of E/Vp,E/Em and N-terminal pro-B-type natriuretic peptide（NT-proBNP）,③Analysis the feasibility of E/Vp,E/Em on left ventricular diastolic function evaluation.Results ①Compared with control group,E/Vp and E/Em were highter in patients with heart failure,the differences were statistically significant（all P〈0.01）,②With the grade of NYHA increasement,E/Vp heighten subsequently,and had a correlation with NT-proBNP（r=0.77,P〈0.01）,③ When the E/Vp≥1.32,area under the ROC curve in diagnosis of left heart diastolic dysfunction was 0.90,the sensitivity was 74%,specificity was 96%,When the E/Em≥ 9.11,area under the ROC curve in diagnosis of left heart diastolic dysfunction was 0.85,the sensitivity was 61%,specificity was 92%.Conclusion E/Vp measured by dual Doppler modality simultaneously have good reproducibility,which can be used to evaluate the left ventricular diastolic function accurately in patients with heart failure.