组织多普勒评估缺血性心肌病与扩张型心肌病患者功能性二尖瓣反流程度差异的价值

Value of tissue Doppler imaging to evaluate the degree of functional mitral regurgitation in ischemic versus idiopathic dilated cardiomypathy

目的分析组织多普勒(tissue Doppler echocardiography,TDI)用于评价患者功能性二尖瓣反流(functional mitral regurgitation,FMR)程度差异的价值。方法选取明确诊断为缺血性心肌病(ICM)的患者33例,扩张型心肌病(DCM)患者27例,均合并不同程度FMR。用传统超声心动图测得舒张末期左心室内径(LVEDD)、收缩末期左心室内径(LVESD)、左心室射血分数(LVEF)、左房内径(LAD)、二尖瓣瓣叶舒张早期峰值运动速度(E)、舒张晚期峰值运动速度(A)与E/A值;用组织多普勒测量二尖瓣环收缩期峰值运动速度(Sm)、舒张早期峰值运动速度(Em)、舒张晚期峰值运动速度(Am)、E/Em值及PASP值;用彩色多普勒血流会聚方法测得二尖瓣有效返流口面积(EROA)表示FMR严重程度。对两组患者上述数据进行统计学比较分析。结果 ICM与DCM患者的传统超声心动图指标:LVEF、LVEDD、LVSED、LAD、E、A、E/A值比较,差异无显著性意义,P>0.05。而组织多普勒测量指标比较结果显示:ICM组E/Em高于DCM组,而Sm、Em、Am值均低于DCM组,差异有显著性意义,P<0.05。同时ICM组EROA及PASP值亦高于DCM组,差异有显著性意义,P<0.05。结论TDI能够更好地反映二尖瓣的功能状态,对缺血性心肌病与非缺血性扩张型心肌病功能性二尖瓣反流程度差异的评估更准确。

Objective To determine the value of tissue Doppler imaging （TDI） in evaluation the degree of functional mitral regurgitation（FMR） in isehemic cardiomyopathy （ICM） versus idiopathic dilated cardiomyopathy （DCM）. Methods We prospectively enrolled patients with functional MR secondary to ICM （ n = 33 ） and DCM （ n = 27 ）. LVEDD, LVESD, LVEF, LAD, E, A, E/A were obtained by traditional echocardiography. And Sm, Em,Am, E/ Em, PASP were obtained by color tissue Doppler imaging and effective regurgitate orifice area （EROA） was obtained by the color Doppler flow convergence to evaluate the degree of FMR. All of the parameters and outcomes of the two group patients were analyzed. Results There were no differences in the data of traditional echocardiography ： LVEDD, LVESD, LAD, LVEF, E, A, E/A between the two group patients （P 〉 0.05）. While the levels of Era, Sm, Am in ICM group were significantly lower than DCM group （ P 〈 0.05 ）, and the E/Em, EROA, PASP were higher than DCM group （P 〈 0.05 ）. Conclusion TDI is better than conventional echocardiography to assess the function of the mitral valve. It is better and more sensitively reflect the difference at the degree of FMR between the two group patients.