法洛四联症修补术后伴肺动脉返流患者的心肌组织多普勒成像Tei指数的研究

Tei指数(即心肌活动指数)是一种评价心脏收缩或舒张功能的新指标，既往多用于左心室功能评估。近来有研究表明，Tei指数还可运用于胎儿、儿童和成人的各种心脏疾病的右心室功能的评价。该研究对比研究了脉冲多普勒或组织多普勒方式在对法洛四联症修补术后伴肺动脉瓣返流(PR)患者心功能测定中的意义。     

多普勒组织成像评价正常人心肌舒缩运动速度

目的　探讨心肌舒缩运动变化的相关因素。方法　标准切面 (左心室长轴、短轴 )用脉冲多普勒组织成像(DTI)测定室间隔、前壁、下后壁的内膜下心肌及外膜下心肌运动峰值速度。结果　各个室壁及各层心肌收缩期 s峰值速度不相同。内膜下心肌的 s峰值速度大于外膜下心肌的 s峰值速度 ,室间隔左心室面 s峰值速度大于右心室面 s峰值速度 ,两者间存在速度阶差。长轴左心室后壁 s峰值速度大于室间隔 s峰值速度 ,短轴后壁 s峰值速度大于前壁 s峰值速度。 s峰值速度与年龄无相关 ,舒张期 a峰值速度与年龄呈中度相关 ,e/ a比与年龄呈中度负相关 ,室壁运动的 e/ a比与二尖瓣血流 E/ A比呈中度相关。结论　脉冲 DTI可用于评价心肌的舒缩功能     

多普勒组织成像技术对正常胎儿心肌运动的初步研究

目的　运用多普勒组织成像技术研究胎儿心肌运动的可行性。方法　 40例不同胎龄的正常妊娠的胎儿进行了多普勒组织成像检查 ,运用速度图模式测量室间隔及二尖瓣环的收缩及舒张运动速度 ,比较不同孕期和不同部位的心肌运动速度。结果　胎儿心肌的峰值运动速度随胎龄的增长而增大 ,室间隔的运动速度明显低于二尖瓣环的速度。结论　运用多普勒组织成像技术研究胎儿心肌的运动是可行的且有价值的 ,可作为一种新的评价胎儿心功能的方法 ,值得进一步研究。     

二维超声与定量组织多普勒技术观察缩窄性心包炎患者心包与心肌运动

目的:用二维超声与定量组织多普勒技术观察心包和心肌的运动,评价其在缩窄性心包炎诊断中的价值。方法:二维超声分别观察25例正常人、22例缩窄性心包炎患者左室后壁和下壁壁层心包与心肌(包括外层心肌和内层心肌)在心动周期中的运动及差异,应用定量组织多普勒成像技术测量壁层心包、外层心肌和内层心肌收缩期峰值位移(D1、D2和D3),分别计算外层心肌与壁层心包、内层心肌与外层心肌收缩期峰值位移的比值(D2/D1、D3/D2)。结果:常规二维超声显示正常组外层心肌的运动幅度高于壁层心包,而内层心肌和外层心肌运动基本一致;缩窄性心包炎由于心包脏壁两层粘连,导致外层心肌运动受限,与壁层心包接近,而内层心肌的运动幅度高于外层心肌。正常组外层心肌与壁层心包的收缩期峰值位移之比(D2/D1)高于缩窄性心包炎组,差异有统计学意义[(2.03±0.42)和(1.48±0.53),P0.05];而缩窄性心包炎组内层心肌与外层心肌收缩期峰值位移的比值(D3/D2)高于正常组,差异亦有统计学意义[(2.16±0.30)和(1.23±0.29),P0.05]。结论:应用二维超声结合定量组织多普勒成像技术观察心包与心肌在心脏收缩期的动态变化,发现缩窄性心包炎患者和正常人有明显差异,可为缩窄心包炎的诊断提供新的依据。     

超声心动图定量组织速度成像评价动脉粥样硬化兔心肌功能

目的:探讨超声心动图定量组织速度成像评价动脉粥样硬化(AS)兔模型整体及局部心肌功能的应用价值.方法:20只兔分为2组:10只为AS组,以高脂饮食饲养12周建立AS模型;10只为正常组,以普通饲料饲养.成模后行常规超声心动图检测左室短轴缩短率(FS)、射血分数(EF)、二尖瓣口血流速度(E)等指标;定量组织速度成像(QTVI)检测后间隔、前侧壁、前壁和下壁中段局部心肌收缩期峰值速度(Sm)和舒张期峰值速度(Em);检测并计算二尖瓣环后间隔、前侧壁、前壁和下壁4个位点收缩期峰值速度的平均值(Sa)作为QTVI整体收缩功能指标,舒张期峰值速度的平均值(Ea)和二尖瓣口舒张期血流速度E与Ea的比值(E/Ea)作为QTVI整体舒张功能指标.结果:①常规超声心动图指标EF[(66.6±4.5)∶(68.2±5.7)%]、FS[(33.6±3.2)∶(34.9±4.3)%]及二尖瓣口血流速度E[(0.9±0.1)∶(0.9±0.1)m/s]在2组间差异无显著性.②QTVI指标显示AS组整体心功能降低,表现为Sa[(4.3±1.0)∶(6.1±0.6)cm/s]和Ea[(3.8±1.4)∶(6.8±0.7)cm/s]降低,E/Ea升高(0.17±0.08:0.09±0.02).③QTVI指标显示AS组局部心肌功能下降,表现为前壁[(2.3±1.7)∶(4.9±2.1)cm/s]和下壁[(3.7±1.6)∶(5.5±1.1)cm/s]中段心肌Em降低,下壁中段心肌Sm降低[(3.0±0.6)∶(4.3±0.5)cm/s].结论:QTVI是评价AS兔模型整体及局部心肌功能的敏感方法.     

多普勒超声Tei指数评价川崎病恢复期患儿心功能

目的应用多普勒超声Tei指数探讨恢复期川崎病（KD）患儿的心脏整体功能变化。方法选择KD恢复期患儿52例及正常对照组40例,常规检测其左室射血分数（LVEF）、E/A比值及左、右心Tei指数,进行组间对比。结果恢复期KD患儿LVEF、E/A比值均在正常范围,与正常组比较无明显差异;与正常组比较,其左、右心室Tei指数显著延长（左心0.41±0.12vs0.29±0.08,右心0.36±0.14vs0.24±0.09,P<0.01）。结论恢复期KD患儿存在左、右心室Tei指数延长和心脏整体功能的异常;多普勒超声Tei指数是评价恢复期KD左右心室整体功能的指标之一。     

测定左室Tei指数方法初探

目的探讨左室Tei指数的测定方法。方法30例正常体检者用脉冲多普勒超声心动图采集二尖瓣和主动脉瓣血流频谱得出左室Tei指数,其结果作为对照组,并与CW、M超,TDI方法测定结果比较。结果PW联合法测得Tei指数为0.50±0.22、CW联合法测得Tei指数为0.46±0.17与对照组(0.32±0.09)有明显差异。结论不同测定方法测量的Tei指数无显著差异,但同一方法中联合法与分开法有显著性差异。     

应用解剖M-型超声评价左室Tei指数

目的本研究利用解剖M-型、脉冲多普勒超声心动图测量30例健康者左室Tei指数,旨在对两种方法所测结果进行对比性分析。方法在解剖M-型条件下,在同一心动周期内同时记录二尖瓣及主动脉瓣活动曲线,分别测量等容收缩期(ICT)、主动脉瓣开放时间(ET)和等容舒张期(IRT),输入机器后自动得出Tei指数。在脉冲多普勒条件下,于心尖四腔观和心尖五腔观分别获得二尖瓣口和主动脉瓣口血流频谱,测量包括ICT、IRT、ET在内的各个时间间期并通过超声诊断仪自动计算出左室Tei指数。结果解剖M-型与脉冲多普勒法测得Tei指数之间的比较差异无统计学意义,且相关性好。结论解剖M-型是一种较为简便、理想的测定Tei指数的方法。     

组织多普勒成像Tei指数在妊娠中期胎儿心室功能评价中的应用

目的探讨组织多普勒成像（TDI）评估妊娠中期正常胎儿心室功能的价值。方法采用TDI技术测量68例孕13-27周胎儿左、右心室多普勒时间间期,获得等容收缩及舒张时间和射血时间,计算左、右心室Tei指数,分析其与孕龄、心率的相关性。结果妊娠中期正常胎儿Tei指数左心室为0．36±0．09,右心室为0．35±0．10,两者具有相关性（r=0．436,P〈0．01）,心率、胎龄与Tei指数无相关性（P〉0．05）。结论Tei指数是一种简单可靠的定量综合评价心脏收缩和舒张功能的多普勒指数,不受心室心率、孕龄影响,可用于观察胎儿心功能变化。     

组织多普勒心肌速度梯度的研究现状及临床应用进展

组织多普勒成像 (TissueDopplerimaging ,TDI)技术问世以来 ,广泛用于测量心肌的运动速度 ,评估左室收缩及舒张功能。但由于多普勒技术检测探头方向上的速度 ,必然受到心脏整体运动及多普勒入射角的影响 ,使得定量评价左室功能的准确性受到限制。1　心肌速度梯度 (Myocardialvelocity gradient,MVG)的基本概念1 .1 　MVG及测量方法由于心肌各层的运动速度并不一致 ,1 994年Fleming等〔1〕首次提出用MVG的概念 (国内有学者将其称为心肌速度阶差 ) ,MVG指心内膜与心外膜速度之差与室壁厚度 (L)的比值 ,用公式表示为 :MVG =(Vend-Vep…     

组织多普勒Tei指数评价晚期肝硬化患者右心室整体功能

目的应用组织多普勒Tei指数的方法评价晚期肝硬化患者的右心整体功能。方法应用组织多普勒Tei指数的方法对30例晚期肝硬化患者（肝硬化组）及35例年龄相匹配的正常人（正常对照组）测量右心室舒张末期内径、右室流出道内径（RVDd）、右室等容舒张时间（IRT）、等容收缩时间（ICT）、射血时间（ET）及Tei指数（Teiindex）,对比上述参数分析右心室整体功能。结果晚期肝硬化患者右室舒张末期内径、右室流出道内径、等容舒张时间及Tei指数均明显高于正常对照组,两者比较差异具有显著性（P〈0.05）;右室射血时间及Ea/Aa〔运动速度（Ea）、舒张晚期运动速度（Aa）〕与正常对照组相比明显减低,两者比较差异有显著性（P〈0.05）;但右室等容收缩时间与正常对照组比较差异无显著性（P〉0.05）。结论晚期肝硬化患者存在右心整体功能的异常,主要是舒张功能受损。     

Evaluation of Tissue Doppler Tei index for global left ventricular function in mice after myocardial infarction: comparison with Pulsed Doppler Tei index.

AIM: The Pulsed Doppler Tei index is a parameter to evaluate combined systolic and diastolic function in humans. However, one major limitation is that the parameters of Pulsed Doppler Tei index cannot be measured within one cardiac cycle. Therefore, accuracy of the Pulsed Doppler Tei index may be affected by anesthesia induced heart rate variation in mice echocardiography. Tissue Doppler Imaging (TDI) enables us to measure both relaxation and contraction velocities simultaneously. Thus, the aim of our study was to validate TDI and Pulsed Doppler Tei index and their reproducibility in mice after experimental anterior myocardial infarction (MI). METHODS AND RESULTS: Pulsed Doppler Tei index and TDI Tei index were assessed before and 4 weeks after MI. Both parameters increased significantly after MI (Pulsed Doppler: 0.4+/-0.04 to 0.7+/-0.03; P<0.001; TDI: 0.2+/-0.03 to 0.5+/-0.04; P<0.0001). In addition, TDI Tei index showed a good correlation with ejection fraction and fractional shortening, and was indicated by better reproducibility than Pulsed Doppler Tei index. CONCLUSION: Tissue Doppler Tei index is appropriate to characterize global left ventricular function in mice after MI.     

Assessment of the Tei index by tissue Doppler imaging in patients with acromegaly: serum growth hormone level is associated with the Tei index

BACKGROUND: The Tei index reflects both systolic and diastolic ventricular function. The aim of this study was to assess the Tei index by tissue Doppler imaging (TDI) and also to evaluate the correlation with growth hormone (GH) and the Tei index and left ventricular (LV) function assessed by TDI in patients with acromegaly. METHODS: We prospectively evaluated 25 patients with acromegaly and 27 control subjects. LV systolic and diastolic function was assessed by conventional echocardiography and TDI. RESULTS: Peak E velocity and E/A ratio were lower in those with acromegaly than in those without (P = 0.01; P = 0.002, respectively). Deceleration time of the mitral E-wave (P = 0.01) and isovolumic relaxation time (IVRT) (P = 0.01) were higher in acromegalic patients than those in controls (P = 0.006, P = 0.002). Em (P = 0.01) and Em/Am (P = 0.001) were lower in patients with acromegaly than in controls. In patients with acromegaly, the Tei index was significantly higher than that in controls (0.49 +/- 13.4 vs 0.39 +/- 5.2, P = 0.005). GH was positively correlated with the Tei index (r = 0.65, P = 0.041), Em/Am (r = 0.63, P = 0.021), and interventricular septum (IVS) thickness (r = 0.65, P = 0.008) only in patients with acromegaly. LV diastolic dysfunction was detected 36% by conventional echocardiography and 48% by the Tei index derived from TDI in acromegalic patients. CONCLUSION: TDI analysis of mitral annular velocities is useful to assess LV diastolic dysfunction in patients with acromegaly. GH was positively correlated with the Tei index and LV diastolic dysfunction. The Tei index may be superior to conventional mitral Doppler indices for identification of LV diastolic dysfunction in patients with acromegaly.     

多普勒组织成像技术在急性心肌梗死中的应用

多普勒组织成像技术是一项应用多普勒原理分析心肌组织运动的一项超声新技术。急性心肌梗死患者的超声心动图检查主要表现有心功能下降,节段性室壁运动异常等,多普勒组织成像技术可对急性心肌梗死患者的心肌运动进行客观定量的分析,并且具有无创、可重复等优点,能够对患者的心功能、室壁运动、心肌存活性、预后等方面做出更为准确的判断。     

Left ventricular Tei index: comparison between flow and tissue Doppler analyses

BACKGROUND: It is still unknown whether a correlation exists between left ventricular Tei index obtained by tissue Doppler imaging and that determined by flow Doppler waveforms. This study was conducted to evaluate their relationship and to assess the positional effect on them. METHODS: Twenty-six healthy subjects and 25 patients with essential hypertension were included. On the tissue Doppler images, the time interval from the end to the onset of the mitral annular velocity pattern during diastole and the duration of the S-wave were used to calculate tissue Doppler Tei index. RESULTS: The tissue Doppler Tei index correlated with the flow Doppler Tei index at sitting position (r = 0.406, P = 0.003), but not at left lateral decubitus position. The limits of agreement for the Tei index measured by both methods were -0.26 to 0.62 at left lateral decubitus position and -0.09 to 0.55 at sitting position. Preload reduction associated with sitting position with dangling feet raised the Tei index both in the healthy controls [0.54 (0.14) vs 0.42 (0.12), P < 0.001] and in the hypertensives [0.53 (0.15) vs 0.46 (0.12), P = 0.005]. There was a similar positional effect on the tissue Doppler Tei index in the control subjects [0.75 (0.12) vs 0.53 (0.10), P < 0.001]. CONCLUSIONS: Tissue Doppler Tei index does not seem to be a suitable substitute for flow Doppler Tei index. Flow Doppler Tei index is preload dependent and the loading status should be taken into consideration at the application of Tei index to the evaluation of myocardial performance.     

Assessment of Left Ventricular Function and Tei Index by Tissue Doppler Imaging in Patients with Slow Coronary Flow

Background: The aim of this study was to assess left ventricular (LV) function and the Tei index by tissue Doppler imaging (TDI), and also to evaluate the relationship of thrombolysis in myocardial infarction (TIMI) frame count (TFC) with the Tei index and LV function in patients with slow coronary flow (SCF). Methods: We prospectively evaluated 50 patients with SCF and 27 control subjects. Diagnosis of SCF was made by TFC. LV systolic and diastolic function was assessed by conventional echocardiography and TDI. Results: Early diastolic mitral annular velocity (Em), Em/Am, and peak systolic mitral annular velocity (Sm) were lower in patients with SCF than those in controls (13±2.8 cm/sec vs 15.2±2.8 cm/sec, P = 0.002; 0.88±0.22 vs 1±0.23, P = 0.03; and 14.1±3.51 vs 16.5±3.31, P = 0.005, respectively). In patients with SCF, the Tei index was significantly higher than that in controls (0.34±9.6 vs 0.29±9.5, P = 0.02, respectively). Mean TFC and RCA TFC were positively correlated with the Tei index (r = 0.3, P = 0.02 and r = 0.329, P = 0.02). Left circumflex (LCX) TFC was negatively correlated with Em/Am (r =–0.310, P = 0.03) only in patients with SCF. Conclusion: LV systolic and diastolic function is impaired in patients with SCF. TDI analysis of mitral annular velocities such as the Tei index, Em, Em/Am, and Sm is useful to assess LV systolic and diastolic dysfunction in patients with SCF. Mean TFC and RCA TFC were positively correlated with the Tei index and LCX TFC was negatively correlated with Em/Am. TDI may be better than conventional echocardiography in assessing LV function in patients with SCF. (ECHOCARDIOGRAPHY, Volume 26, November 2009)     

Tei指数评价风湿性心脏病二尖瓣狭窄患者左心室功能

目的运用脉冲型组织多普勒技术(PW-TDI)测算左心室心肌综合指数(Tei指数),评价风湿性心脏病二尖瓣狭窄(MS)患者左心室功能,并探讨其与右心室功能的关系。方法测量30例MS患者及25例健康对照者的常规超声心动图指标,在PW-TDI条件下测算左心室二尖瓣环四个位点(后间隔、侧壁、前壁、下壁)的Tei值及其均值(t-Tei)以及三尖瓣环位点(右心室游离壁)的Tei值,对各组值进行对比分析。结果(1)与正常对照组相比,MS患者左、右心室的Tei值明显增大(P<0.001);左心室二尖瓣环四个位点t、-Tei、右心室三尖瓣环位点的等容舒张时间延长(P<0.001)、射血时间缩短(P<0.01或P<0.05),前壁、下壁及t-Tei等容收缩时间延长(P<0.05);(2)相关性分析表明MS患者左、右心室的Tei指数呈正相关关系(r=0.73,P<0.001)。结论MS患者左心室在收缩功能正常时舒张功能已减退,左、右心室功能状态可能相互影响,重视改善MS患者左心室功能具有重要的临床意义。     

Novel Application of Tissue Doppler Imaging

Tissue Doppler imaging was used with transthoracic and transesophageal echocardiography to determine its clinical usefulness beyond visualization of ventricular wall motion. Thirteen novel applications were found: acoustically difficult transthoracic studies, thrombus, mitral chordal motion, shunt detection using saline contrast, spontaneous echo contrast, intra-aortic balloon pump position and function, endocarditis (prosthetic and native), valve strands (prosthetic and native), mobile aortic atheroma, prosthetic valve motion, aortic valve motion in the presence of a calcified aortic annulus, systolic anterior motion of the mitral valve, and cardiac tumors. Tissue Doppler imaging directly affected the ability to make difficult diagnostic decisions with increased confidence and reduced the need for additional studies.     

特发性室性期前收缩患者心肌运动速度的变化及意义

目的:应用组织多普勒成像(TDI)技术研究特发性室性期前收缩(PVB)患者心肌运动速度的变化.方法:研究对象为30例特发性PVB患者(期前收缩组)及30例健康受试者(对照组).应用组织多普勒成像技术测量心肌组织运动速度及时间速度积分指标以反映PVB对心脏舒缩功能的影响.结果:对照组与期前收缩组正常窦性搏动时各取样点心肌组织运动速度及时间速度积分指标的比较:在所有位点,期前收缩组正常窦性搏动时的各项指标与对照组比较,差异均无统计学意义(P均＞0.05).与正常窦性搏动比较,在所有位点PVB时的收缩期峰值速度、收缩期时间速度积分、舒张早期峰值速度、舒张早期晚期峰值速度比值均显著下降(P均＜0.01),差异有统计学意义,而PVB后第一个窦性搏动的收缩期峰值速度、收缩期时间速度积分和舒张早期峰值速度在各位点均较正常窦性搏动时显著增加(P均＜0.01),差异有统计学意义;舒张晚期峰值速度在各位点的不同心动周期中差异均无统计学意义(P均＞0.05).结论:PVB及其代偿间期可显著影响心室的收缩及舒张功能.