老年冠心病患者左心室收缩和舒张功能障碍诊断方法的价值及其相关关系

The value of some diagnostic methods for systolic and diastolic dysfunction of left ventricle and their correlations in the senile patients with coronary heart disease

目的 探讨临床心功能分级 (NYHA)诊断、有创与无创检查方法对老年冠心病患者左心室收缩、舒张功能障碍的诊断价值及其相关关系。方法 5 6例老年冠心病患者 ,分别用左心室X线造影、多普勒超声心动图和核素心室造影方法测定不同NYHA分级时的左心室射血分数 (LVEF)、E峰、A峰、E A比值和二尖瓣前瓣活动曲线EF斜率以及左心室高峰射血率 (PER)、左心室高峰充盈率 (PFR)值 ,并进行比较和相关分析。结果 心功能Ⅲ级组的LVEF值低于心功能Ⅰ、Ⅱ级组 ,Ⅱ或Ⅲ级组超声LVEF高于同组其他方法LVEF值 ,Ⅰ、Ⅱ、Ⅲ级组间PER的比较差异有显著性意义 ;Ⅲ级组E峰、E A比值和EF斜率低于Ⅰ级组 ;不同方法LVEF值间具有正相关性 ,PER与LVEF间也有正相关性 ;NYHA分级与LVEF、PER间呈负相关 ,与年龄呈正相关 ,与E峰、E A、EF斜率以及PFR也呈负相关 ;年龄与E峰、EF斜率以及PFR均呈负相关 ;PFR与E峰、E A、EF斜率均呈正相关 (P <0 .0 5或 <0 .0 1)。结论 核素心室造影、多普勒超声心动图检测均有利于对老年冠心病患者左心室收缩、舒张功能障碍的诊断。

Objective To study the diagnostic value of clinical NYHA diagnosis and traumatic and non traumatic diagnostic methods for systolic or diastolic dysfunction of left ventricle and their correlations in the senile patients with coronary heart disease.Methods Fifty six senile patients with coronary heart disease were selected to examine the left ventricle ejection fraction (LVEF), E peak, A peak, E/A ratio, EF slope,left ventricular peak ejection rate (PER) and left ventricular peak filling rate(PFR) at different NYHA degrees and to analyze their correlations.Results The LVEF value of heart function grade Ⅲ group was lower than that of grade Ⅰand Ⅱ groups. The LVEF value of grade Ⅱand Ⅲ groups measured by the Doppler echocardiogram(DECG) was higher than that of the same groups measured by other methods. The PER between heart function grade Ⅰ,Ⅱ,Ⅲ groups was discrepant. E peak , E/A ratio and EF slope measured by DECG in grade Ⅲ group were lower than those in grade Ⅰ group.There were positive correlations between the LVEF values measured by different methods and between PER and LVEF. The NYHA grades were negatively correlated with LVEF, PER, E peak, E/A ratio, EF slope and PFR and positively correlated with the age. The age was negatively correlated with E peak, EF slope and PFR . The PFR was positively correlated with E peak, E/A ratio and EF slope(all P<0.05 or <0.01).Conclusions The nuclide ventricle imaging is most propitious for judging the systolic dysfunction, and the DECG is most suitable for judging diastolic dysfunction in the senile patients with coronary heart disease.