组织多普勒技术评价慢性肾功能不全患者心室功能

Assessment of ventricular function by pulsed Doppler tissue imging in patients with chronic renal failure

目的 :探讨应用组织多普勒技术 (DTI)测量慢性肾功能不全 (CRF)的心肌运动速度频谱 ,评价心功能的价值。方法 :5 3例CRF ,根据内生肌酐清除率 (Ccr)分成尿毒症组 34例 (A组 )和氮质血症组 19例 (B组 ) ,2 8例正常对照组 (C组 ) ,在左室侧壁二尖瓣环、间隔二尖瓣、右室游离壁三尖瓣环 ,以及左室后壁心内膜、心外膜五个位点 ,记录收缩期S波、舒张早期E波、舒张晚期A波峰值、速度时间积分 ,以及时间指标。结果 :A、B组各瓣环E波及积分、E/A比值及E/A积分比值 ,左室后壁舒张期最大跨壁速度梯度均较C组显著降低 ,左室侧壁二尖瓣环S峰及S积分、间隔二尖瓣环S积分也较C组显著降低。心电图Q波至三处瓣环E峰的时间间隔在A、B两组有显著差异 (P <0 .0 5 )。结论 :CRF患者左右心室舒张功能减退 ,左右心室间舒张不同步 ,左室收缩功能也有减退证据。DTI技术可以很好地评价此类患者的心室功能。

Objective:To assess the ventricular function by pulsed Doppler tissue imaging (DTI) in patients with chronic renal failure (CRF).Methods:53 patients with CRF were examined by DTI and were divided into 2 groups according to endogenous creatinine clearance rate (Ccr).28 healthy subjects were examined as control.DTI measurements were taken at lateral and septal mitral annulus and tricuspid annulus in the apical 4-chamber view,endocardium and epicardium of the LV posterior wall in the parastrnal short axis view.Results:Early diastolic peak velocity (E) and velocity time integral (VTI) of mitral and tricuspid annulus,E/A ratio and E/A integral ratio,and peak diastolic myocardial velocity gradient (MVG) of LV posterior wall were significantly lower in CRF patients than controls.Systolic peak velocity (S) and S-VTI in lateral mitral annulus and S-VTI in septal mitral annulus were significantly lower in CRF patients.The time interval from Q wave of electrocardiogram to the onset of E wave at different annulus were significantly different in CRF patients.Conclusion:Left and right ventricular diastolic function are both impaired in CRF,including diastolic asynchrony between left and right ventricles.LV systolic function is impaired in CRF although LVEF is nomal.DTI has distinct value in assessing ventricular function in CRF patients.