B型脑利钠肽和Tei指数在高血压早期左心室舒张功能不全诊断中的意义

目的探讨B型脑利钠肽(BNP)与Tei指数在评价原发性高血压左心室舒张功能不全中的意义。方法选择高血压患者83例,分为高血压伴左心室舒张功能不全组(DHF组,35例),高血压无心力衰竭组(NHF组,48例),另选健康体检者20例作为对照组。化学发光法检测BNP,超声心动图检测各个参数,并计算左心室Tei值。结果DHF组Tei指数、BNP明显高于NHF组和对照组(P<0.01),NHF组Tei指数、BNP也明显高于对照组(P<0.05,P<0.01)。BNP法诊断敏感性、特异性明显好于Tei指数法,差异有统计学意义(P<0.05)。结论BNP和Tei指数均为诊断高血压早期舒张功能不全的敏感指标,且BNP法较Tei指数法更为高效、准确。     

原发性高血压患者左心室功能的临床研究

目的探讨原发性高血压患者左心室功能的临床研究。方法原发性高血压患者176例,按Ganau法分为4型:正常构型组(A组)46例、向心性重构组(B组)53例、向心性肥厚组(C组)40例、离心性肥厚组(D组)37例;正常对照组35例。超声心动图测量舒张末室间隔厚度(IVS)、左心室后壁厚度(LVPW)及左心室舒张末期内径,二尖瓣血流频谱左心室舒张早期血流峰速(E),舒张晚期血流峰速(A)值比,左心室射血分数(LVEF)及Tei指数。各组血浆脑钠肽(BNP)浓度对比分析。结果正常对照组与高血压各组比较,在年龄、性别均差异无显著性意义,C组、D组收缩压最高,左心房内径最大(P<0.05);B组、D组IVS、LVPW轻度增厚(P<0.05);高血压各组的E/A值均降低(P<0.05),LVEF值只有D组与正常对照组比较差异有显著性意义;各组Tei指数差异有显著性意义;BNP在B组、C组、D组差异有显著性意义。结论Tei指数,BNP共同评价原发性高血压患者不同左心室构型的心功能情况,对原发性高血压的治疗效果和预后有临床应用价值。     

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。     

Effect of cilnidipine on left ventricular function in hypertensive patients as assessed by tissue Doppler Tei index

Tissue Doppler Tei index is pointed to be more effective in the evaluation of global cardiac function than systolic and diastolic measurements alone in various heart diseases. This study was designed to assess the effect of cilnidipine on left ventricular function in hypertensive patients by using this index. A group of 40 hypertensives (mean age 55+/-8 years, range: 35-65) and 16 controls (mean age 52+/-9 years, range: 36-65) were included. Hypertensives were classified into non-left ventricular hypertrophy (NLVH) group (25 patients) and left ventricular hypertrophy (LVH) group (15 patients), and treated with cilnidipine for 2 months. Before and after treatment, the participants were examined by echocardiography. Tissue Doppler Tei index was calculated as diastolic time interval measured from end of late diastole to origin of early diastole (a') minus systolic Sm duration (b') divided by b', that is Tei index = (a'-b')/b'. Thirty-seven hypertensive patients finished the treatment. Tei index was significantly higher in NLVH and LVH groups than in control group, and in LVH group than in NLVH group (0.44+/-0.07 vs 0.28+/-0.06, P < 0.001; 0.51+/-0.13 vs 0.28+/-0.06, P < 0.001; 0.51+/-0.13 vs 0.44+/-0.07, P < 0.05). After treatment, Tei index was significantly decreased (0.40+/-0.11 vs 0.46+/-0.10, P < 0.0001); systolic blood pressure and diastolic blood pressure were also decreased significantly. In conclusion, Tei index is impaired in hypertensives before development of ventricular hypertrophy and impairment is more prominent in hypertrophy. Cilnidipine can improve left ventricular function. Tissue Doppler Tei index is gaining importance in evaluating LV function after drug intervention in hypertensive patients.     

首发AMI患者急诊PCI术后BNP水平与Tei指数的相关性研究

目的：探讨首发急性心肌梗死（AMI）急诊经皮冠状动脉介入（PCI）术后脑利钠肽（BNP）水平与Tei指数相关性。方法：80例首发AMI急诊PCI术后患者,根据Gensini积分分为轻度冠脉病变组（20例）、中度冠脉病变组（30例）和重度冠脉病变组（30例）,同期入选30例冠脉造影正常者为正常对照组,比较各组的Tei指数与BNP。结果：AMI患者Tei指数明显高于正常对照组（0．38±0．08）;在AMI患者,重度冠脉病变组InBNP水平明显高于中度冠脉病变组[（5．42±0．33）ug／L比（5．09±0．24）pg／L],重度冠脉病变组Tei指数明显高于轻、中度冠脉病变组[（0．54±0．07）比（0．39±0．05）、（0．43±0．05）],P均〈0．01;直线相关分析显示,Tei指数与InBNP水平、Gensini积分呈正相关（r=0．612,0．862,P均〈0．01）,与LVEF呈负相关（r=-0．601,P〈0．000）;InBNP与Gensini积分相关性分析,r=0．437,P〈0．05。结论：Tei指数结合BNP检测用于评估急性心肌梗死的心功能及预后可能更为准确。     

Impaired myocardial performance in sarcoidosis

Despite myocardial sarcoid involvement has been reported in 20-27% in autopsy series, only 5% of the patients are clinically symptomatic. This study was planned to evaluate right and left ventricular functions in patients with early stage sarcoidosis (stage I and II) without any findings of cardiac involvement with Tei index which globally shows systolic and diastolic functions of the ventricles was used. Seventy-two patients under follow-up for sarcoidosis without cardiac involvement (53 women, 19 men; mean age 49.1 ± 10.3 years) and nineteen age-matched healthy control subjects (14 women, 5 men; mean age 48.7 ± 6.5 years) were enrolled in the study. All subjects were evaluated with two-dimensional and Doppler echocardiography. Right and left ventricle Tei indices (myocardial performance index) were calculated from measured Doppler parameters. Peak velocity of the mitral A wave (A) was higher, peak velocity of the mitral E wave, E/A ratio were lower; and ejection time was shorter in patients with sarcoidosis (p< 0.05) compare to controls. Peak velocity of the tricuspid A wave was higher, E wave deceleration time was longer and E/A ratio was lower (p< 0.05) in sarcoidosis group. While left ventricular Tei index was higher in patients with sarcoidosis (p= 0.021), right ventricular Tei index was similar to healthy controls' (p>0.05). Left ventricular myocardial performance is disturbed in patients with early stage sarcoidosis. This can be related to a subclinical involvement of sarcoidosis.     

阻塞性睡眠呼吸暂停综合征患者血浆超敏C反应蛋白和IL-6水平的观察

目的观察阻塞性睡眠呼吸暂停综合征(OSAS)患者血浆超敏C反应蛋白(hsCRP)与白细胞介素6(IL-6)水平,及其对于无创正压通气(nCPAP)的反应。方法选择多导联睡眠监护(PSG)证实为OSAS的25例患者作为实验组,另外15例无OSAS的健康者为对照组,观察两组清晨血浆hsCRP与IL-6差异,观察实验组血浆hsCRP、IL-6与睡眠呼吸暂停指数(AI)的关系、nC-PAP治疗1个月后的变化。结果OSAS患者血浆hsCRP、IL-6明显高于对照组(P均<0.05),hsCRP、IL-6与睡眠AI均呈现出较好的相关性(P均<0.05),但与IL-6不同,OSAS患者清晨与夜间睡前CRP浓度比较差异无显著性(P>0.05)。经nCPAP治疗后OSAS患者血浆hsCRP与IL-6浓度均显示显著降低(P均<0.05)。结论OSAS患者血浆hsCRP、IL-6水平明显升高,且可通过nCPAP治疗得到降低,相比IL-6、hsCRP更能反映OSAS患者慢性炎症状态。     

Prognostic impact of plasma brain natriuretic peptide for cardiac events in elderly patients with congestive heart failure

BACKGROUND: Plasma brain natriuretic peptide (BNP) has been reported to be useful in determining the prognosis of patients with ischemic heart disease and cardiomyopathy. However, aging increases the level of plasma BNP; therefore, the prognostic impact of plasma BNP in elderly patients with congestive heart failure has not been fully established. OBJECTIVE: We sought to determine whether plasma BNP could predict recurrent cardiac events in elderly patients with congestive heart failure. METHODS: Forty-eight consecutive elderly patients (>65 years old) were enrolled in the present study. All patients were admitted with their first episode of congestive heart failure. Clinical characteristics, plasma BNP, left ventricular ejection fraction, and left ventricular mass index were compared between patients with and those without recurrent cardiac events. RESULTS: During the follow-up period, twelve cardiac events were observed. The New York Heart Association functional class was signi- ficantly higher in patients with cardiac events than in those without (p < 0.05). The plasma BNP level in pa- tients with cardiac events was significantly higher than in those without (521.0 +/- 156.0 vs. 126.8 +/- 20.1 pg/ml, p<0.001), despite more frequent treatment with angiotensin-converting enzyme inhibitors (75 vs. 28%, p<0.05). The left ventricular ejection fraction was significantly lower and the left ventricular mass index higher in patients with cardiac events as compared with those without (38.1 +/- 5.0 vs. 49.2 +/- 2.4%, p < 0.05; 193.8 +/- 14.3 vs. 132.6 +/- 7.8 g/m(2), p < 0.001, respectively). The plasma BNP was selected as an independent factor associated with cardiac events besides New York Heart Association functional class, left ventricular ejection fraction, and left ventricular mass index using multivariate Cox proportional-hazards regression analysis (hazard ratio = 2.656, p<0.05). The cardiac event rate was significantly higher in patients with a plasma BNP concentration >132 pg/ml using Kaplan-Meier analysis (p < 0.001). Moreover, the plasma BNP level correlated inversely with the length of time from hospital discharge to a cardiac event (r = -0.575, p<0.05). CONCLUSION: Measuring the plasma BNP level before hospital discharge in elderly patients with congestive heart failure was more useful than other conventional examinations for predicting the recurrence of cardiac events.     

Long-term effects of nasal continuous positive airway pressure on vasodilatory endothelial function in obstructive sleep apnea syndrome

Obstructive sleep apnea syndrome (OSAS) is associated with a dysfunction of vascular endothelial cells. The aim of this study was to investigate long-term improvement of endothelial dysfunction in OSAS with nasal continuous positive airway pressure (nCPAP) treatment. We investigated endothelium-dependent and endothelium-independent vasodilatory function in patients with OSAS using the hand vein compliance technique. Dose–response curves to endothelium-dependent vasodilator bradykinin were obtained in 16 subjects with OSAS before and after 6 months of nCPAP therapy and in 12 control subjects without OSAS. Maximum dilation (Emax) to bradykinin, being impaired in all OSAS patients, was completely restored with nCPAP. Mean Emax to bradykinin rose from 54.9±18.5 to 108.2±28.7% with 164.4±90.0 nights of nCPAP therapy (p<0.0001; Emax healthy controls, 94.8±9.5%). At treatment follow-up, endothelium-dependent vasodilatory capacity was not significantly different in nCPAP-treated OSAS patients vs healthy controls. Mean vasodilation with endothelium independently acting nitroglycerin was not altered initially and did not change with nCPAP therapy indicating that nCPAP restored endothelial cell function and not unspecific, endothelium-independent factors. These results suggest that regular nocturnal nCPAP treatment leads to a sustained restoration of OSAS-induced impaired endothelium-dependent nitric oxide-mediated vasodilation, suggesting an improvement of systemic endothelial dysfunction in patients studied.     

Which Factors Impact Myocardial Function in Systemic Sclerosis?

Background: The aim of our study was to determine clinical and echocardiographic parameters, which impacted the left (LV) and right ventricular (RV) diastolic and global function in patients with systemic sclerosis (SSc). Methods: The study included 50 SSc patients and 48 age‐matched healthy volunteers. All the patients underwent clinical examination, serological tests, pulmonary function testing, and complete two‐dimensional echocardiography, which included pulsed and tissue Doppler. We determined the ratio of early diastolic transtricuspid/transmitral and the lateral area of the tricuspid/mitral annulus flow velocities (E/e′;_lateral). RV and LV global ventricular function was estimated by the Tei index. Pulmonary vascular resistance (PVR) was calculated by using echocardiographic parameters. Results: Tricuspid inflow E/A ratio was decreased in the SSc group (P < 0.001), also as e′/a′ ratio (P < 0.001), whereas E/e′_tricuspid was increased (P = 0.001). The RV Tei index was increased in SSc patients (P < 0.001). PVR was significantly higher than in controls (P < 0.001). The multivariate analysis showed that brain natriuretic peptide (BNP) level (β= 0.403, P = 0.016), diffusion capacity for carbon monoxide (DLCO; β= 0.361, P = 0.025), RV systolic pressure (β= 0.449, P = 0.011), and PVR (β= 0.507, P < 0.001) were independently associated with RV diastolic function (tricuspid E/e′_lateral). Similar results were achieved for the RV Tei index. Multiple regression showed that BNP level (β= 0.337, P = 0.029), DLCO (β= 0.405, P = 0.011), and PVR (β= 0.449, P = 0.022) were independently associated with LV diastolic function (mitral E/e′_lateral). Similar results were obtained for the LV Tei index. Conclusion: Our study revealed some new noninvasive parameters (BNP, DLCO, and PVR), which are useful for everyday clinical practice for determining of early myocardial involvement in SSc. (Echocardiography 2012;29:307‐317)     

Bedside tests of B-type natriuretic peptide in the diagnosis of left ventricular diastolic dysfunction in hypertensive patients

AIMS: To investigate the value of B-type natriuretic peptide (BNP) in diagnosing left ventricular diastolic dysfunction in patients with hypertension. METHODS: The left ventricular diastolic function and plasma BNP levels were assessed prospectively in 135 hypertensive patients. RESULTS: The plasma BNP in patients with (n=61) and without (n=74) diastolic dysfunction was 122+/-105 and 18+/-16 pg/ml, respectively (p<0.001). Increased BNP levels were associated with systolic blood pressure (p<0.05), left ventricular mass index (p<0.001), the E/A ratio of transmitral flow (p<0.01) and the isovolumic relaxation time (p<0.01). A receiver-operator characteristic curve showing the sensitivity and specificity of BNP against the echocardiography diagnosis of diastolic dysfunction revealed an area under the curve (accuracy) of 0.904 (p<0.01). Using a cut-off value of >40 pg/ml, the sensitivity and specificity of plasma BNP in diagnosing left ventricular diastolic dysfunction were 79% and 92%, respectively. CONCLUSIONS: The plasma BNP levels in patients with hypertension are closely related to left ventricular hypertrophy and filling impairment. Plasma BNP may be used to facilitate the diagnosis of left ventricular diastolic dysfunction.     

NT-proBNP is not elevated in patients with obstructive sleep apnoea

BACKGROUND: N-terminal pro-brain natriuretic peptide (NT-ProBNP) has emerged as an important marker of cardiac stress and may reflect the severity of underlying cardiac dysfunction, which is thought to be associated with obstructive sleep apnoea syndrome (OSAS). METHODS: This study evaluated the plasma concentration of NT-ProBNP in 60 consecutive patients (median age 55.7 years, median body mass index (BMI) 31.8) who were referred to a sleep laboratory with a suspicion of OSAS. Each subject underwent measurement of morning NT-ProBNP plasma levels, polysomnography and echocardiography. Patients were treated with nasal continuous or bilevel positive airway pressure ventilation (nCPAP/BIPAP) or without mechanical respiratory support, depending on clinical symptoms and results of polysomnography. Three months after treatment of OSAS 28 of the patients were reassessed for re-evaluation of NT-ProBNP and polysomnography. RESULTS: Low or high levels of NT-proBNP were not associated with AHI and other sleep related indices (p>0.3). There was no correlation between NT-proBNP and AHI or other sleep related indices. In multiple regression analysis, NT-proBNP was significantly correlated with left ventricular ejection fraction, creatinine clearance and the presence of systemic arterial hypertension but not with AHI. CONCLUSIONS: Our results show by a robust multiple regression analysis, that NT-pro BNP is not associated with OSAS and NT-pro BNP cannot be used as a sensitive marker for underlying cardiovascular abnormalities in patients with OSAS.     

脑钠肽及Tei指数联合评价高血压性心脏病患者心功能的临床研究

目的探讨脑钠肽（BNP）及Tel指数评价高血压性心脏病患者心功能的临床意义。方法89例高血压性心脏病患者，按照其入院时NYHA心功能分级分为心功能Ⅰ级、Ⅱ级、Ⅲ级、Ⅳ级组。21例选自本院体检中心的心功能正常者作为对照组。行超声心动图检查测出rrei指数、左室射血分数（LVEF）、左室重量指数（LVMI），并检测血BNP。结果随着心功能分级程度的加重rrei指数与血BNP水平逐渐增加，Tei指数均值在心功能Ⅰ级、Ⅱ级、Ⅲ级、Ⅳ级分别为0．40±0．12、0．49±0．09、0．58±0．18和0．69±0．07；BNP均值在心功能I级、Ⅱ级、Ⅲ级、Ⅳ级分别为42．19±17．51、297．45±21．92、703．12±15．76和912．75±37．16（pg／m1），组间比较P〈0．05，差异有统计学意义。除BNP指标在心功能Ⅰ级组与对照组比较差异无统计学意义（P〉0．05）外，余指标均明显高于对照组[Tei指数对照组0．31±0．08，BNP对照组（33．12±3．15）pg／ml]（P〈0．05），差异有统计学意义。随心功能障碍程度的加重，血BNP水平升高，并且和Tei指数、LVMI呈正相关（r分别为0．563，0．368，P〈0．05）；与左室射血分数（LVEF）呈负相关（r=-0．372，P〈0．05）。结论在高血压性心脏病患者中，血BNP水平与Tei指数、心功能以及左室构型之间有较好的相关性，血BNP水平与Tei指数能综合反映心脏的功能。     

Doppler echocardiography-derived index of myocardial performance (TEI index): comparison with brain natriuretic peptide levels in various heart disease.

Plasma brain natriuretic peptide (BNP) has diagnostic and prognostic value in heart failure. Cardiac dysfunction varies from systolic or diastolic dysfunction alone to the combination of both. In the present study, Doppler echocardiographic parameters, including the Doppler echocardiography-derived index (TEI index), were compared with plasma BNP levels in 74 patients with various heart diseases. Blood sampling was performed before an echocardiographic examination was conducted. The TEI index was defined as the summation of isovolumic contraction and relaxation time divided by ejection time. In patients with left ventricular (LV) systolic dysfunction (ejection fraction <50%), the TEI index and BNP were increased significantly compared with patients with normal LV systolic function (p<0.05). Patients with a TEI index > or =0.45 showed significantly increased BNP levels compared with patients with a TEI index <0.45, irrespective of LV systolic function (241.4+/-451.2 vs 65.9+/-81.8pg/ml; p<0.05). The TEI index was significantly higher in patients with a BNP > or =73pg/ml than in patients with BNP <73pg/ml (0.57+/-0.24 vs 0.46+/-0.17; p<0.05). Other echocardiographic parameters did not correlate significantly with levels of plasma BNP. Of the echocardiographic parameters, a simple Doppler index (TEI index) that combines systolic and diastolic function can detect LV dysfunction in patients with high levels of plasma BNP in various heart diseases.     

Importance of left ventricular activation in determining myocardial performance (Tei) index: comparison with total isovolumic time

BACKGROUND: The Tei index is commonly used as a measure of "combined systolic and diastolic function". A sensitive and specific index of intrinsic myocardial contraction and relaxation would be independent of abnormal activation. We aimed to determine whether the Tei index fulfils this criterion in patients with normal activation or left bundle branch block (LBBB), normal or dilated left ventricular (LV) cavities, with or without coronary artery disease (CAD). METHODS: We studied 32 controls and 124 patients; 49 had CAD and normal LV size (11 LBBB), 27 had non-ischaemic dilated cardiomyopathy (DCM, 11 LBBB), and 48 had ischaemic DCM (17 LBBB). Tei index (isovolumic contraction time+isovolumic relaxation time/ejection time) and total isovolumic time (t-IVT: [60-(total ejection time+total filling time]) were measured using Doppler echocardiography. RESULTS: Tei index and t-IVT were prolonged in LBBB (by 0.6 and 9.1 s/min, P<0.001). T-IVT identified LBBB with greater predictive accuracy than Tei index (sensitivity 97% vs. 90%, specificity 93% vs. 91%, P<0.05). Tei index and t-IVT were also prolonged in DCM (by 0.2 and 3.1 s/min, both P<0.001). Although Tei index identified DCM with sensitivity 71%, this fell to 53% when LBBB was excluded (P<0.05). CAD had no effect on Tei index or t-IVT. CONCLUSIONS: The Tei index is not a measure of intrinsic myocardial systolic and diastolic function, since its main determinant is ventricular activation rather than cavity size. T-IVT, however, is more sensitive to activation, is unrelated to cavity size or CAD, and may thus be a more accurate measure of the mechanical consequences of ventricular activation in a variety of cardiac conditions.     

An Echocardiographic Study of the Limitations of the Tei Index in Aortic Stenosis

Background: The omnibus Tei index, the sum of isovolumic contraction and relaxation times divided by the ejection time, is a good indicator of global cardiac function. However, these time intervals can be influenced by valvular heart disease and the role of the Tei index among patients with aortic stenosis (AS) and left ventricular systolic dysfunction remains incompletely defined. Methods: Doppler time intervals were measured retrospectively by two observers, and the Tei index were calculated on 80 patients with various degrees of left ventricular systolic dysfunction and severity of AS. Differences between observers were resolved by consensus. Ejection fraction (EF) was visually estimated, and the aortic valve area (AVA) was calculated using the continuity equation. Results: The mean AVA was 1.1 ± 0.5 cm² and the mean EF was 0.39 ± 0.15. Although correlation (r = 0.61, P < 0.001) and agreement (intraclass correlation coefficient = 0.55) for the Tei index were satisfactory, there were significant differences between observers (P < 0.001). Using consensus data, the mean Tei index was 0.32 ± 0.20 and significantly lower among patients with severe compared with less severe AS (P = 0.01). The index varied inversely with left ventricular function (P = 0.003). However, receiver operating characteristic analysis shows that the Tei index lacks discrimination in accurately identifying poor left ventricular function or severe AS or both. Conclusion: The Tei index varies inversely with systolic ventricular function (low index with good EF) and positively with severity of AS (low index with smaller valve area). As such, it may have limited utility among individual patients with AS.     

超声心动图评价高龄高血压患者左心室收缩与舒张功能

目的探讨超声心动图各指标评估高龄老年高血压患者左心室不同构型的收缩与舒张功能的临床价值。方法将高龄老年原发性高血压患者153例,按Ganau法分为4组:正常构型组(47例)、向心性重构型组(35例)、向心性肥厚型组(33例)和离心性肥厚型组(38例);另选无心肺疾病的患者65例为正常对照组。超声心动图测量舒张末期室间隔厚度(IVS)、左心室后壁厚度(LVPW)、左心室内径(LVEDD)、二尖瓣血流频谱图舒张早期与晚期血流峰值比(E/A)、LVEF及Tei指数。结果正常对照组及以上4组E/A均<1;离心性肥厚型组LVEF明显降低(P<0.05),正常构型组、向心性重构型组、向心性肥厚型组比较无显著差异;以上4组Tei指数与正常对照组比较差异有显著性意义(P<0.05),但4组间比较无显著差异,Tei指数和E/A无相关性,Tei指数和LVEF呈负相关(r为-0.594,P<0.001)。结论Tei指数较E/A及LVEF更能全面评价高龄老年高血压患者心脏的收缩和舒张功能。     

Tei指数评价左心室射血分数正常的尿毒症患者的左心室功能

目的利用Tei指数评价左心室射血分数（left ventricular ejection fraction, LVEF）正常的尿毒症患者的左心功能,以了解其临床应用价值。方法选取80例LVEF正常的尿毒症患者设为尿毒症组,50名健康人设为对照组,使用Vivid7pro对两组进行检测。检测左心房内径（LAD）、左心室舒张期末内径（LVDd）、左心室收缩期末末内径（LVDs）、室间隔（IVS）及左心室后壁厚度（LVPW）、LVEF、左心室短轴缩短率（LVFS）、二尖瓣血流频谱E峰及A峰、E／A比值、左心室等容收缩时间（ICT）及等容舒张时间（IRT）、主动脉射血时间（ET）,并计算左心室Tei指数。结果尿毒症组左心房内径、左心室舒张期末内径、左心室收缩期末内径、室间隔、左心室后壁厚度均较对照组增大,差异有统计学意义（P均〈O．01）。尿毒症组的二尖瓣血流频谱E峰及A峰较对照组明显增大（P均〈0．05）、左心室等容舒张时间比对照组延长（P〈0．01）、主动脉射血时间比对照组缩短（P〈0．01）、Tei指数比对照组明显延长（0．50±0．18眠0．33±0．12,P〈0．叭）,差异有统计学意义;尿毒症组E／A比值、左心室等容收缩时间、LVEF及左心室短轴缩短率与对照组比较,差异无统计学意义（P均〉0．05）。结论测量Tei指数能比单纯LVEF更好地评价尿毒症患者的左心功能,而且方便、快捷、有效。     

Functional assessment by myocardial performance index (Tei index) correlates with plasma brain natriuretic peptide concentration in patients with hypertrophic cardiomyopathy.

BACKGROUND: Hypertrophic cardiomyopathy (HCM) might exhibit not only diastolic, but also latent systolic dysfunction. Therefore combined assessment of both systolic and diastolic function using myocardial performance index (Tei index) can be useful in HCM. Plasma brain natriuretic peptide (BNP) level is reported to be elevated in HCM, but the mechanism of BNP elevation in HCM remains to be established. METHODS AND RESULTS: The value of Tei index in 45 HCM patients was compared with that of 20 normal control subjects. The HCM patients showed a higher value of Tei index (0.55+/-0.12 vs 0.36+/-0.08, p < 0.0001) and longer isovolumic relaxation and contraction times than control subjects. The plasma BNP level correlated with Tei index in non-obstructive HCM (n = 35, r = 0.61, p < 0.0001), although the correlation was mild when overall HCM patients were included (r = 0.34, p = 0.02). The correlation was still significant after adjusting for age, or the extent and severity of left ventricular hypertrophy. Multiple stepwise regression analysis identified mitral E/A ratio (r = 0.49, F = 13.1) and Tei index (r = 0.37, F = 7.6) as independent predictors of higher plasma BNP level in non-obstructive HCM. CONCLUSIONS: Myocardial performance index was abnormal in HCM, reflecting both systolic and diastolic dysfunction in this disorder. Plasma BNP level correlated with functional assessment by Tei index in non-obstructive HCM.     

Clinical significance of plasma atrial and brain natriuretic peptide levels during hemodialysis in hemodialysis patients with old myocardial infarction

OBJECTIVES: The plasma levels of atrial natriuretic peptide(ANP) and brain natriuretic peptide(BNP) are useful to evaluate left ventricular function in patients with old myocardial infarction(OMI). This echocardiographic study examined the clinical importance of the measurement of ANP and BNP in patients with OMI undergoing hemodialysis. METHODS: ANP and BNP levels were measured before and after hemodialysis in 36 patients with OMI and 42 patients without ischemic heart disease as controls(control group). Echocardiography was performed after hemodialysis. The patients with OMI were classified into two groups according to left ventricular percentage fractional shortening(% FS): Normal(OMI-N) group with %FS > or = 30%(n = 19) and low (OMI-L) group with %FS < 30%(n = 17). RESULTS: The ANP, BNP levels and BNP/ANP ratio before and after hemodialysis were significantly higher in the OMI-L group than in the other groups. BNP level was significantly inversely correlated with %FS(r = -0.60, p < 0.05) and correlated with E wave and E/A, in mitral inflow only in the OMI-L group. The decrease in BNP level during hemodialysis was significantly greater in the OMI-L group than in the other groups, but not in ANP level. CONCLUSIONS: These findings suggest that ANP and BNP levels are increased in patients with left ventricular dysfunction undergoing hemodialysis compared to those with normal left ventricular function. ANP level is convenient for decision of suitable dry weight. In contrast, BNP level that correlated inversely with impairment of left ventricular function is a more sensitive index of left ventricular function than ANP in patients with OMI undergoing hemodialysis.