组织多普勒成像中二尖瓣舒张早期峰速/二尖瓣瓣环舒张早期峰速、二尖瓣舒张早期峰速/(二尖瓣瓣环舒张早期峰速×二尖瓣瓣环收缩期峰速)对冠状动脉搭桥术后心力衰竭评估价值

E/Em′and E/(Em′×Sm′)in tissue Doppler imaging for the evaluation of heart failure after coronary artery bypass grafting

目的探讨组织多普勒成像(TDI)中二尖瓣舒张早期峰速(E)/二尖瓣瓣环舒张早期峰速(Em′)、E/[Em′×二尖瓣瓣环收缩期峰速(Sm′)]对冠状动脉搭桥术(CABG)后心力衰竭的评估价值。方法回顾性分析北部战区总医院2020年1月1日—10月1日收治的非体外循环下行CABG的470例患者的临床资料。根据术后第2天的脑钠肽平均值,将患者分入心力衰竭组(脑钠肽>1000 ng/L,n=169)和非心力衰竭组(脑钠肽≤1000 ng/L,n=301)。超声心动图二维常规模式下测量左房前后径(LAD)、左室舒张末期内径(LVEDd)、左室收缩末期内径(LVSDd);二维双平面Simpson′s法测量左室舒张末期容积(LVEDV)、左室收缩末期容积(LVESV)及左室射血分数(LVEF);脉冲多普勒(PW)测量E、二尖瓣舒张晚期峰速(A);PW-TDI测量Em′、二尖瓣瓣环舒张晚期峰速(Am′)及Sm′,计算E/A、E/Em′、E/Am′、E/(Em′×Sm′)、E/(Am′×Sm′)。比较两组患者的TDI参数,采用多因素Logistic回归分析CABG后发生心力衰竭的独立预测因子,采用受试者工作特征曲线进行真实性验证。结果与非心力衰竭组比较,心力衰竭组E/Em′、E/Am′、E/(Em′×Sm′)、E/(Am′×Sm′)升高,Em′、Am′、Sm′降低,差异有统计学意义(P<0.05)。年龄、脑血管病、LVEF、E/Em′、E/(Em′×Sm′)是CABG后发生心力衰竭的独立预测因子(P<0.05)。E/(Em′×Sm′)对CABG后心力衰竭的预测性较好,截断值为1.59,灵敏度为43.20%,特异度为79.10%。结论E/(Em′×Sm′)有可能成为评估CABG后心力衰竭的早期指标。

Objective To evaluate the value of E/Em′and E/(Em′×Sm′)in tissue Doppler imaging(TDI)for heart failure after coronary artery bypass grafting(CABG).Methods A retrospective analysis was performed on the clinical data of 470 cases of CABG treated in General Hospital of Northern Theater Command from January 1,2020 to October 1,2020.Patients were divided into the heart failure group(brain naturetic peptide>1000 ng/L,n=169)and the non-heart failure group(brain naturetic peptide≤1000 ng/L,n=301)according to the mean value of brain naturetic peptide on the second postoperative day.Left atrial dimension(LAD),left ventricular end diastolic diameter(LVEDd)and left ventricular end systolic volume(LVSDd)were measured in two-dimensional conventional echocardiography.Left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV)and left ventricular ejection fraction(LVEF)were measured by the two-dimensional biplanar Simpson′s method.Pulsed-wave Doppler(PW)measured E and A.PW-TDI measured Em′,Am′and Sm′,calculated E/A,E/Em′,E/Am′,E/(Em′×Sm′)and E/(Am′×Sm′).TDI parameters were compared between the two groups.Multivariate Logistic regression was used to analyze independent predictors of heart failure after CABG,and the authenticity was verified by the subject operating characteristic curve.Results Compared with non-heart failure group,E/Em′,E/Am′,E/(Em′×Sm′)and E/(Am′×Sm′)in heart failure group were increased,while Em′,Am′and Sm′were decreased,the difference was statistically significant(P<0.05).Age,cerebrovascular disease,LVEF,E/Em′,E/(Em′×Sm′)were independent predictors of heart failure after CABG(P<0.05).The predictive value of E/(Em′×Sm′)for heart failure after CABG was 1.59,the sensitivity was 43.20%,and the specificity was 79.10%.Conclusion E/(Em′×Sm′)may be used as an early indicator of heart failure after CABG.