肺、心导纳血流图联合应用对左室舒张功能的诊断价值

Diagnostic value of admittance pneumography combining with admittance cardiography for assessing left ventricular diastolic function

目的 是以核素心室造影 (简称 :心血池 )的PFR(峰充盈率 )及LVEF(左室射血分数 )为对照 ,探讨心、肺导纳图联合应用对左室舒张功能的诊断价值。方法 118例研究对象包括健康对照 30人 (男性 18人 ,女性 12人 ,平均年龄 5 4 4岁± 7 8岁 ) ;高血压和 /或冠心病 (心绞痛、陈旧心梗 )病人 89人 ,后者依心血池的PFR及LVEF结果分为 :心功能正常组 (PFR≥ 2 0 ,LVEF≥ 5 0 % ) 19人 (男 12人 ,女 7人 ,平均年龄 5 4 8岁± 8 9岁 ) ;单纯舒张功能障碍组(PFR <2 0 ,LVEF≥ 5 0 % ) 30人 (男 19人 ,女 11人 ,平均年龄5 4 1岁± 8 8岁 ) ;舒张及收缩功能障碍组 (PFR <2 0 ,LVEF<5 0 % ) 39人 (男 2 4人 ,女 15人 ,平均年龄 5 4 4岁± 9 7岁 )。99mTcPYP示踪剂 ,平衡法测LVEF、PFR、HR。同一天内进行机测心导纳的LVEF、肺导纳的Ha(房缩波a波高度 )、HS(室宿波S波高度 )、HD (室舒波D波高度 )、Ha/HS和HD/HS比值。比较病人各组各参数与健康对照组的差别 ,肺导纳各参数与PFR的相关系数 ,心、肺导纳图联合应用对左室功能的诊断符合率。结果 ①与健康对照组相应参数比较 ,心功能障碍的病人组Ha、HD、Ha/HS、HD/HS均明显增高。②全部研究对象的Ha、HD、Ha/HS、HD/HS与PFR呈负相关分别为 - 0 .6 93,- 0 .4 5 7,

Objectives To evaluate the diagnostic value of admittance pneumography combining with admittance cardiography for assessing left ventri cular diastolic function by comparing with radionuclide ventriculography (RVG). Methods 118 people, including 30 healthy controls and 89 patients with coronary artery disease or/and hypertension, underwent RVG, admittance pneumography and admittance cardiography on the same day. According to the results of PFR (peak fill rate )and LVEF (left ventricular ejec tion fraction) of RVG, 89 patients were divided into normal function group (19 patients, male 12, female 7, mean age 59.8 yr±8.9 yr, PFR≥2 0 EDV/S, LVEF≥50%),single diastolic dysfunction group (30 patients, male 19, female 11, mean age 54.1 yr± 8 8 yr , PFR<2 0 EDV/S, LVEF≥50%), systolic and diastolic dysfunction group (39 patients, male 24, female 15, mean age 54.4 yr±9.7 yr, PFR<2 0 EDV/S, LVEF<50%). The relationship between PFR and parameters admittance pneumogram, including Ha (height of a wave), HS(height of S wave), HD (height of D wave), Ha/HS, HD/HS, were analyzed. Compared with PFR or/and LVEF of RVG, the diagnostic correspondent rate of admittance pneumography or uniting LVEF of admittance cardiography (LVEFa) were evaluated. Results ①There were significant higher levels of Ha, HD, Ha/HS, and HD/HS in the patients with left ventricular dysfunction than those in the healthy controls. ② The value of Ha, HD, Ha/HS and HD/HS were negatively correlated to PFR ( r= -0.693 , -0.457 , -0.770 , -0.793 , respectively, P <0 001) in all individual. ③Compared with RVG, the diagnostic correspondent rate of Ha, HD, Ha/HS, HD/HS, Ha/HS+LVEFa and HD/HS+LVEFa were 84 7%, 52 5%, 88 1%,82 2%,81 4% and 86 4%, respectively. The diagnostic correspondent rate of HD/HS was higher than of Ha/HS (90% vs 70%) in single diastolic dysfunction group, but was lower (62% vs 100%) in systolic and diastolic dysfunction group. Conclusions Ha/HS and HD/HS of admittance pneumogram are negatively correlated to PFR of RVG significantly. There are higher diagnostic correspondent rates between Ha/HS, HD/HS associated with LVEF of admittance cardiogram and RVG on assessing left ventricular diastolic function.