多普勒组织成像与二维超声检测梗死心肌运动的比较研究

目的 比较多普勒组织成像（TDI）速度图与常规二维（2D）超声图在检测急性心肌梗死患者节段性室壁运动异常的差异，评估TDI诊断梗死缺血心肌运动的价值。方法对48例健康者和22例急性心肌梗死患者行常规2D超声检查。对心尖四腔切面、二腔切面、左室长轴切面、胸骨旁左室长轴切面和短轴切面的室壁运动，使用TDI技术测量各室壁节段内膜下心肌运动峰值速度。在心尖左室长轴上计算跨壁速度梯度。当测量值低于正常对照值下限（均数～1．96标准差），则判断为室壁运动异常。设置对TDI速度图检测数据的可重复性检验。结果TDI速度图对室壁运动异常总的检出率显著高于2D超声（P〈0.01）。依据6例冠状动脉造影结果发现，TDI速度图检测梗死和缺血心肌的准确性和敏感性高于2D超声（P〈0.05），但其特异性低于后者。TDI速度图检测所得的数据有较好的可重复性。结论在检测梗死和缺血心肌室壁运动异常方面。TDI优于常规2D超声。

Comparative study of myocardium motion in myocardial infarction by tissue Doppler imaging in contrast to 2D echocardiography

Objective To evaluate the value of tissue Doppler imaging(TDI) for diagnostic of the regional left ventricular wall motion abnormalities in myocardial infarction(MI) and myocardial ischemia in contrast to two-dimensional(2D) echocardiography.Methods 22 patients with acute myocardial infarction(AMI) and 48 health persons were examined by 2D echocardiography in advance.In six views such as: ap4cv,ap2cv,alax,pslax,pssax(CT) and pssax(PM),the regional left ventricular wall motion was observed according to 16 segments and abnormal movement was recorded.Having switched to TDI in each view,velocities of all segments' motion were measured or calculated by pulsed TDI.The diagnostic result of TDI for detection of myocardium motion in MI and in myocardial ischemia was compared with that of 2D echocardiography and the data of TDI was test in repeatability.Results The total positive rate of pulsed TDI for detection of abnormal motion was significantly larger than that of 2D echocardiography(P<0.01).The accuracy(P<0.05) and the sensibility(P<0.05)of pulsed TDI for detection of myocardium in MI and in myocardial ischemia were larger than those of 2D echocardiography,but the specificity of pulsed TDI was smaller than that of 2D echocardiography.The data repeatability of TDI was better.Conclusion The diadynamic value of TDI for detection of ventricular wall motion abnormalities in MI and in myocardial ischemia is more excellent than that of 2D echocardiography.