多普勒组织成像评价扩张型心肌病患者右心室长轴心肌等容收缩期运动

目的 探讨扩张型心肌病（DCM）患者右心室长轴心肌等容收缩期多普勒组织成像（DTI）特点及其临床意义。方法 应用DTI技术检测了28例DCM患者右心室游离壁近三尖瓣环处心肌等容收缩期正向波（IVC1）峰值速度（VIVC1）、速度时间积分（VTIIVC1）、持续时间（TIVC1），负向波（IVC2）峰值速度（VIVC2）、速度时间积分（VTIVC2）、持续时间（TIVC2）以及射血波（S）峰值速度（Vs）、速度时间积分（VTIs）、持续时间（Ts）等指标，测量右心室面积变化率（RVPCA）等，并与30例正常人对比分析。结果DCM患者VIVC1、VS、VTIs及VIVC1与VIVC2差值（DIVC）均较对照组明显降低（P〈0．1）5～0．01）；VIVC1、VTIIVC2增大（P〈0．01）；TIVC1，TIVC2、Q—IVC1（心电图QRS波始点至IVC，始点间时间）、Q-S（心电图QRS波始点至S波间时间）延长（P〈0．1）5～0．01），（Q-S）／Ts值增高（P〈0．01）；右心室内径增大（P〈0．01），平均RVPCA明显减小（P〈0．01）；VTIIVC1、Ts两组差异无统计学意义（P〉0．05）。结论 DCM患者右心室长轴心肌等容收缩期DTI变化具有一定特点，可为右心室整体功能的评价提供一种新的方法。

Assessment of right ventricular long axis myocardial motion during isovolumic contraction in patients with dilated cardiomyopathy by Doppler tissue imaging

Objective To assess the velocity patterns of right ventricular long axis myocardial motion during isovolumic contraction phase in the patients with dilated cardiomyopathy(DCM) by Doppler tissue imaging(DTI).Methods Right ventricular systolic free wall myocardial(the place close to the tricuspid annular) motion velocities were examined by DTI on apical four-chamber view in 28 patients with DCM and 30 healthy volunteers.Peak positive and negative velocities(V_(IVC1),V_(IVC2)),velocity time integrals(VTI_(IVC1),VTI_(IVC2)),times(T_(IVC1),T_(IVC2)) of right ventricular free wall myocardial motion during isovolumic contraction,and the peak velocity(V_S),time(T_S),velocity time integral(VTI_S) of ejection wave(S) were measured.Right ventricular percent changes in area(RVPCA) on three different views were calculated.Results V_(IVC1),V_S,VTI_S and differential IVC(the difference between V_(IVC1) and V_(IVC2)) in the patients with DCM were significantly decreased than those in control group(P<(0.05)-(0.01)),V_(IVC2) and VTI_(IVC2) were significantly increased(P<(0.01)).T_(IVC1),T_(IVC2),Q-IVC_1(the time from the start of electrocardiographic QRS wave to the onset of IVC_1),Q-S(the time from the start of electrocardiographic QRS wave to the onset of S wave) were significantly longer in the patients than in control group(P<(0.05)-(0.01)),(Q-S)/Ts was higher(P<(0.01)),right ventricular diameter was bigger(P<(0.01)),and mean RVPCA of three different views was significantly decreased(P<(0.01)) in the patients with DCM.There was no significant statistic difference between two groups for VTI_(IVC1) and T_S(P>(0.05)).Conclusions The changes of DTI indices of right ventricular long axis myocardial motion during isovolumic contraction in the patients with DCM are characteristic,which could be a new method to evaluate right ventricular systolic function.