Tei指数评价胎儿Ebstein畸形右心功能的研究

目的:探讨Tei指数结合三尖瓣环位移(TASE)及右心室面积变化分数(FAC)在评价胎儿Ebstein畸形右心功能中的应用价值。方法:应用多普勒超声心动图技术估测17例Ebstein畸形胎儿和51例正常胎儿的右心室Tei指数、TASE、FAC及E/A并进行对比分析。结果:Ebstein畸形组右心室Tei指数(0.76±0.41)明显高于正常对照组(0.33±0.05),差异有统计学意义(P0.01)。反映右心室收缩功能的TASE和FAC病变组明显低于正常对照组[(0.56±0.24)vs.(0.90±0.09);(0.28±0.10)vs.(0.53±0.08),P0.01)差异有统计学意义。而反映右心室舒张功能的E/A比值两组分别为[(0.67±0.12)vs.(0.67±0.09),P0.05)差异无统计学意义。结论:Tei指数作为一个定量反映整体心肌性能指标,不受心脏几何形状、心率、房室瓣反流和孕龄的影响,结合TASE及FAC,可以简单、准确、更为全面的了解胎儿Ebstein畸形的右心功能,对预后分析、围产期管理提供帮助。     

心室Tei指数对恶性淋巴瘤患者左心功能评价的价值

目的通过超声心动图测定的心室Tei指数评价恶性淋巴瘤患者化疗后早期心功能变化的临床意义。方法采用PHILIPS HDI 5000,Acuson Sequoia 512彩色多普勒超声诊断仪,对49例恶性淋巴瘤患者化疗前(Ⅰ组),化疗后(Ⅱ组)及30例正常人(Ⅲ组)进行二尖瓣前叶EF斜率、二尖瓣血流舒张早期最大流速(EV)与舒张末期最大流速(AV)的比值E/A等左心室舒张功能指标,射血分数(EF)、短轴缩短率(FS)等收缩功能指标,以及左心室Tei指数的测定。结果恶性淋巴瘤患者化疗后Ⅱ组患者左心室Tei指数大于Ⅰ组及Ⅲ组(P<0.01)。Ⅰ组及Ⅲ组间Tei指数差异无显著意义(P>0.05)。EF斜率、E/A、EF%及FS%各组间比较,差异无显著意义(P>0.05)。结论Tei指数能较敏感地对恶性淋巴瘤患者化疗后心功能改变进行评价,具有临床应用价值。     

Tei指数在脐带绕颈胎儿心室功能监测中的意义

目的 探讨晚期妊娠脐带绕颈时胎儿心肌作功指数Tei指数变化及临床意义.方法 144例行胎儿彩色多普勒超声检查的孕妇,其中脐带绕颈者70例(绕颈组),对照组为74例无脐带绕颈及无宫内窘迫者,监测两组胎儿的左、右心室Tei指数.结果 绕颈组Tei指数明显高于对照组;有窘迫者高于无窘迫者,P均＜0.001.结论 Tei指数不仅可简便有效地评估脐带绕颈时胎儿的心室功能,且可指导临床进行分娩时机和方式的选择.     

Tei指数及其临床应用

Tei指数可以反映心脏收缩及舒张的整体心功能变化,并且Tei指数不依赖心室的几何形态及瓣膜反流,可以准确地估测心脏功能并且具有简便、敏感性高、重复性好等优点。现就Tei指数估测心功能的原理、测量方法、应用情况及存在的问题综述如下。     

Tei指数在心血管疾病中的应用

在心血管病的发病率逐年上升的趋势下,临床上如何早期诊断患者心功能异常,评价治疗效果和判断预后具有重要意义.传统的心室舒缩功能指标都基于对心室几何形态的假设,并在不同程度上受超声透声条件、心率及心脏前后负荷变化的影响,其应用价值尚存在一些争论,近期发展起来的Tei指数能综合评价心脏舒缩功能,弥补了前者不足,Tei指数的应用和完善将对临床心功能的评价更具有指导意义.     

Tei指数在心血管疾病中的应用

在心血管病的发病率逐年上升的趋势下,临床上如何早期诊断患者心功能异常,评价治疗效果和判断预后具有重要意义。传统的心室舒缩功能指标都基于对心室几何形态的假设,并在不同程度上受超声透声条件、心率及心脏前后负荷变化的影响,其应用价值尚存在一些争论,近期发展起来的Tei指数能综合评价心脏舒缩功能,弥补了前者不足,Tei指数的应用和完善将对临床心功能的评价更具有指导意义。     

评价心肌梗死后心室整体功能的新指标——Tei指数

由于心力衰竭和心肌梗死的高发病率，对心功能的评价已成为临床医生日益关注的问题。超声心动图能有效地反映心功能的情况，近年来出现一种新的超声心动图评价指标——Tei指数，能综合评价心室的收缩和舒张功能，文中就Tei指数在心肌梗死后心功能的评价方面作一综述。     

Tei指数评价代谢综合征患者左心室功能的研究

目的通过检测左心室Tei指数来评价代谢综合征(MS)患者左心室功能的变化。方法 83例MS患者,分为非左室肥厚组(51例)与左室肥厚组(32例)。对照组为健康体检者85例。测定两病例组及对照组的左室射血分数(LVEF)及Tei指数。结果所有受试者LVEF正常。MS患者无论有无左室肥厚,其左心室Tei指数均显著大于对照组。MS左室肥厚组的左心室Tei指数较非左室肥厚组有增大的趋势。结论 MS早期,左室结构尚未出现改变时已经有左室舒张功能的减低,左室肥厚的发生会进一步加重左室舒张功能的障碍。左心室Tei指数增加对于MS左室收缩功能尚未发生改变时,及早发现左室舒张功能障碍具有一定意义。     

胎儿心脏超声中晚孕期各径线及Tei指数测值与胎龄关系的研究

目的 探讨胎儿心脏超声中晚孕期各径线及Tei指数测值与胎龄关系的研究。方法 选取2014年11-2016年2月,胎儿心脏行心脏超声显示大致正常者共176例。以孕周数作为分组依据,共分为5组,分别为孕22周（n=50）、孕23周（n=50）、孕24周（n=50）、孕32周（n=17）、孕34周（n=9）。应用专业超声心动图仪器对胎儿心脏进行检查,并对心脏结构及功能正常的胎儿心脏进行常规指标的测量及记录,随后对孕龄分别是22、23、24孕周数的正常胎儿的心脏各项测量指标进行专业的统计学分析,进而得到各测量指标的医学参考值范围。利用各个孕周数胎儿心脏各项指标的测量数值进行统计分析,从而比较相关指标间的差异,寻找内在医学规律。结果 1 在课题研究期间,通过对符合条件的入组对象心脏超声各常规指标进行测量及统计,得出了煤炭总医院正常胎儿22、23、24孕周心脏超声各指标的医学参考值范围。 2胎儿的心脏在解剖学和功能学上显示为右心占有优势,即与成人心脏的左心优势呈现相反的情况。在胎儿时期,人类心脏及大血管的各部位的内径测量值均随着孕龄的增加而加大,在统计学上呈现线性相关。各孕周胎儿心脏超声的Tei指数,均在较恒定的范围内波动,不随孕龄的变化而大幅度的改变,所以该指标是评价胎儿心脏功能的一个良好指标。结论 通过课题研究所得的正常胎儿心脏超声心动图指标的参考范围可为煤炭总医院胎儿心脏超声检查提供一定的参考依据。胎儿心脏有其自身的特殊性,其内在的规律对检查及临床诊治具有较高的指导意义。     

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。     

Left ventricular Tei index in athletes

I read with great interest the recently published study by Stoylenet al.¹ in the December, 2003, issue of European Journal ofEchocardiography     

Left ventricular geometry in pregnancy-induced hypertension

The changes induced by transient hypertension upon cardiac geometry (G) are unclear. Pregnancy-induced hypertension (PIH) offers a natural and spontaneous model of this condition. To assess geometric changes according to two-dimensionally guided M-mode echocardiography, we compared patients with PIH with normal pregnant women (NPW). Fifty-five women, aged 28.5 +/- 7.5 years, with PIH (defined as blood pressure >140/90 mm Hg in the third trimester of pregnancy and without a history of hypertension) were compared with 57 NPW aged 30.7 +/- 7.5 years. Left ventricular mass index (LVMI) (Devereux formula) and relative wall thickness (RWT) (Ganau formula) were calculated by means of echocardiography done in the left lateral decubitus 2 to 4 days postpartum. Subjects were considered to have: normal geometry (NG) if both LVMI and RWT fell below the mean +/- 1 SD or 2 SD; concentric hypertrophy (CH) if both were elevated; eccentric hypertrophy (EH) if LVMI was elevated and RWT was normal; and concentric remodeling (CR) if LVMI was normal and RWT was elevated. Comparisons were performed by the Student t test. Patients with PIH had higher LVMI (106 +/- 29.4 v 90.6 +/- 19.8 g/m2; P < .05) and RWT (0.41 +/- 0.07 v 0.38 +/- 0.05; P < .05). Considering the mean +/- 1 SD of NPW as the limit of normality the G pattern was NG in 26 (47%) and abnormal in 29 (53%), of which 14 (25.5%) had EH, 11 (20%) had CR, and four (7%) had CH. If we considered the mean +/- 2 SD, the G pattern was NG in 46 (84%) and abnormal G in nine (16%), EH in four (7%), CR in three (5%), and CH in 2 (4%). According to these data, women with PIH had higher LVMI and RWT compared with NPW. The most frequent abnormal G patterns were EH and CR.     

校正Tei指数在高血压患者左心室功能评价中的应用

目的对比观察传统Tei指数和校正Tei指数对高血压患者左心室功能的评价。方法初诊为高血压未经抗高血压治疗的67例患者根据左心室重量指数分为两组,无心肌肥厚组(A组)32例,心肌肥厚组(B组)35例,另选24例健康体检者为对照组。所有入选者均进行超声心动图、二尖瓣血流频谱和组织多普勒超声显像检查,根据相应公式计算Tei指数和校正Tei指数。结果左心室射血分数在3组间无显著性差异,心肌收缩峰值速度在3组间虽然无显著性差异,但B组较对照组升高明显。二尖瓣瓣尖水平E峰血流速度、E峰血流速度/A峰血流速度以及心肌运动频谱舒张早期峰值速度和舒张早期峰值速度/舒张晚期峰值速度在A、B两组患者显著降低,尤其以B组明显。结论校正Tei指数同传统Tei指数一样能够灵敏准确地评价高血压患者左心室的整体功能,并与传统Tei指数具有很高的相关性。     

Left ventricular function impairment in pregnancy-induced hypertension

The changes induced by transient hypertension on cardiac structure and function are unclear. Pregnancy-induced hypertension offers a natural and spontaneous model of this condition. To assess the potential of echocardiographic Doppler to unmask left ventricular function impairment, we studied 28 women aged 26.4 +/- 7.2 years with pregnancy-induced hypertension defined as blood pressure higher than 140/90 mm Hg in the third trimester of pregnancy without a history of hypertension. Twenty normal pregnant women, aged 27.5 +/- 6.4 years, were the controls. Left ventricular diastolic diameter, fractional shortening, E velocity, A velocity, E/A ratio, isovolumetric relaxation time (IRT), isovolumetric contraction time (ICT), ejection time (ET), and the combined index of myocardial performance (Tei index = IRT + ICT/ET), were calculated by echocardiography Doppler 2 to 4 days postpartum. There were statistically significant differences between groups in the following parameters: E/A ratio: 1.3 +/- 0.3 in pregnancy-induced hypertension v 1.5 +/- 0.3 in normal pregnant women (P < .05), IRT: 104 +/- 14 msec v 84 +/- 7 msec (P < .000), and the Tei index: 0.51 +/- 0.15 v 0.35 +/- 0.04 (P < .00), respectively. According to this data pregnancy-induced hypertension evaluated 2 to 4 days after delivery showed left ventricular dysfunction, mainly diastolic. The IRT and the Tei index are the most useful echocardiographic parameters to unmask left ventricular dysfunction in pregnancy-induced hypertension.     

高血压患者左室重量指数和相对室壁厚度与心率震荡的关系及比索洛尔的干预效应

目的:探讨高血压患者左室重量指数和相对室壁厚度与心率震荡的关系,以及比索洛尔干预后的变化情况。方法:选择首次确诊并有室性期前收缩的高血压患者82例和非高血压患者对照组78例,并根据是否服用比索洛尔,将高血压患者随机设立基础治疗组为对照组(38例)和比索洛尔治疗组(44例);利用24h动态心电图分析系统获得其室性期前收缩,分别计算治疗前及治疗后4周不同分组的震荡初始(TO)和震荡斜率(TS),同期用心脏超声心动图测定其实验前后左室重量指数(LVMI)和相对室壁厚度(RWT)。结果:高血压患者与非高血压患者比较,其TO降低,TS升高(均P0.01);线性相关分析显示高血压患者治疗前RWT与TO及TS无显著相关,LVMI与TO呈正相关,与TS呈负相关;治疗4周后高血压患者LVMI和RWT无显著变化,但TO显著降低,TS显著升高,协方差分析显示,扣除治疗前TO和TS的影响后,比较其校正均数,比索洛尔治疗较基础治疗能进一步改善其心率震荡现象,表现为TO显著降低(F=8.68,P0.05),TS值升高(F=11.32,P0.05)。结论:高血压患者心率震荡现象与其左室重量指数呈正相关,与相对室壁厚度无相关;短期比索洛尔治疗并不能显著改善左室重构,但可显著改善高血压患者的心率震荡现象。     

Relationship between Tei index of myocardial performance and left ventricular geometry in Nigerians with systemic hypertension

Introduction

Left ventricular geometry is associated with cardiovascular events and prognosis. The Tei index of myocardial performance is a combined index of systolic and diastolic dysfunction and has been shown to be a predictor of cardiovascular outcome in heart diseases. The relationship between the Tei index and left ventricular geometry has not been well studied. This study examined the association between the Tei index and left ventricular geometry among hypertensive Nigerian subjects.

Methods

We performed echocardiography on 164 hypertensives and 64 control subjects. They were grouped into four geometric patterns based on left ventricular mass and relative wall thickness. The Tei index was obtained from the summation of the isovolumic relaxation time and the isovolumic contraction time, divided by the ejection time. Statistical analysis was done using SPSS 16.0.

Results

Among the hypertensive subjects, 68 (41.4%) had concentric hypertrophy, 43 (26.2%) had concentric remodelling, 24 (14.6%) had eccentric hypertrophy, and 29 (17.7%) had normal geometry. The Tei index was significantly higher among the hypertensives with concentric hypertrophy (CH), concentric remodelling (CR) and eccentric hypertrophy (EH) compared to the hypertensives with normal geometry (0.83 ± 1.0, 0.71 ± 0.2, 0.80 ± 0.2 vs 0.61 ± 0.2, respectively). The Tei index was higher among hypertensives with CH and EH than those with CR. Stepwise regression analysis showed that the Tei index was related to ejection fraction, fractional shortening and mitral E/A ratio.

Conclusion

Among Nigerian hypertensives, LV systolic and diastolic functions (using the Tei index) were impaired in all subgroups of hypertensive patients according to their left ventricle geometry compared to the control group. This impairment was more advanced in patients with concentric and eccentric hypertrophy.     

Left ventricular wall thickness and plasma catecholamines in borderline and stable essential hypertension

It has been suggested that sympathetic overactivity has a pathogeneticrelevance to left ventricular hypertrophic development, evenapart from its effect on and in essential hypertension. To evaluate this possibility by echocardiographic and polygraphicmethods, we studied left ventricular wall thickness and functionand their possible relationship to plasma renin activity andplasma catecholamines in 11 normal subjects, 13 borderline hypertensivesand 11 stable hypertensives without radiological or electrocardiographicsigns of left ventricular hypertrophy. Compared with normal, borderline hypertensives showed an increasein interventricular septum (IVS) thickness (P < 0.01) andIVS/posterior wall (PW) thickness ratio (P < 0.01) togetherwith an increased supine and upright plasma norepinephrine (NE;P < 0.01); there was also a decreased pre-ejection period(PEP; P < 0.01), PEP/left ventricular ejection time ratio(P < 0.01) and total electromechanical systole (P < 0.05). In stable hypertensives, PW thickness was greater than it wasboth in normals (P < 0.01) and in borderline hypertensives(P < 0.01) and IVS thickness was higher than in normals (P< 0.05). Positive correlations between supine (P < 0.001), upright(P < 0.05) NE and both IVS thickness and IVS/PW thicknessratio were found in borderline but not in stable hypertensives. These results support the hypothesis recently put forward thatIVS hypertrophy may represent an early stage of essential hypertension-inducedLVH, which afterwards extends to the left PW; furthermore theresults suggest that the sympathetic overactivity may play arole in the IVS hypertrophy development in borderline hypertensives.     

Study of the left ventricular function in pregnancy-induced hypertension

Left ventricular (LV) morphological and functional characteristics in 9 women suffering from pregnancy-induced hypertension (PIH) were studied by means of echocardiograms. In order to distinguish which changes depended on the pressure values and which were the result of pregnancy, 10 nonpregnant control women with no heart disease and 10 normal pregnant women (NP) were studied and the results of each of the groups compared. To evaluate the structure, left ventricular systodiastolic diameters and wall thickness were measured. The only statistically significant difference was in the diastolic diameters between the PIH (4.7 +/- 0.3 cm) and the control group (4.4 +/- 0.2 cm) p less than 0.01. Left ventricular mass was significantly increased (p less than 0.01) in the PIH patients (185 +/- 53.1 g) compared to the NP patients (161 +/- 29.6 g) and the control group (125 +/- 17.4 g). No statistically significant differences were found in the radius thickness ratio in the three groups. The systolic function assessed by the shortening percentage was significantly lower (p less than 0.05) in the control group (32.8 +/- 4.4%) and in the NP patients (37.8 +/- 5.2%) than in the PIH group (39 +/- 6.5%). Afterload assessed by isovolumic period stress was significantly greater (p less than 0.01) in the PIH patients (157 +/- 10.6 dyne/cm2) compared with the NP group (118.9 +/- 7.01 dyne/cm2). There were no significant differences between the first group and the control group (134.09 +/- 8.7 dyne/cm2). As evidence of the diastolic function, analysis was made, on the one hand, of diastolic isovolumic period length (DIP).(ABSTRACT TRUNCATED AT 250 WORDS)     

Blood pressure determinants of left ventricular wall thickness and mass index in hypertension: comparing office, ambulatory and exercise blood pressures

Left ventricular (LV) mass relates positively and continuously to cardiac mortality and thus its regression is a rational therapeutic aim. Whilst the office blood pressure (BP) relates poorly to LV mass, it was unclear whether the 24-h ambulatory BP or the exercise systolic BP (ExSBP) was the stronger correlate of LV structural indices. We studied 49 hypertensive patients with a mean age of 45 (s.d. 12) years with a mean body mass index of 27.1(3.9) kg/m(2). The mean (s.d.) of office BP, ambulatory BP and ExSBP measured at the end of the first three stages of Bruce protocol treadmill exercise I, II and III were 161(20)/99(10), 140(13)/89(10), 190(30), 198(30) and 201(33) mm Hg respectively. The LV indices measured echocardiographically were LV septal thickness (IVSd) (1.1(0.2) cm), LV posterior wall thickness (LVPWd) (1.0(0.1) cm) and LV mass indexed to body surface area (LVMI) (123(30) g/m(2)). Age and gender (male) had the highest correlations with the LV indices. Of the BP measures, the stage II ExSBP's correlation with the LV indices was consistently higher than all other ExSBP, office systolic BP and 24-h systolic ambulatory BP. In a stepwise multiple regression analysis on IVSd, after adjusting for age and gender, the stage II ExSBP was independently associated with IVSd (beta= 0.018 (s.e. 0.008), P = 0.024). When only BP measures were considered as explanatory variables only stage II ExSBP was a significant predictor (P = 0.0001) of IVSd as was the case with LVPWd (P = 0.006) and LVMI (P = 0.0008). Submaximal exercise BP measured at a workload comparable to physical activity encountered in daily life correlated more closely with the left ventricular wall thickness and mass. The exercise BP should perhaps be normalised in hypertension management to optimise regression of LV hypertrophy.