组织多普勒评价主动脉瓣反流患者左室整体舒张功能的价值

目的探讨组织多普勒(DTI)评价主动脉瓣反流患者左室整体舒张功能的实用价值。方法将42例经胸超声心动图诊断为主动脉瓣反流患者分为轻度组(9例)和中至重度组(33例),测量主动脉瓣反流束长度、面积及反流角度;应用脉冲多普勒(PW)计算二尖瓣舒张早、晩期峰值血流速度比值(E/A);应用DTI测量二尖瓣环前壁位点运动频谱,计算该位点的舒张早、晩期运动速度比值(Em/Am)。结果轻度组9例,Em/Am均1,E/A均1;Em、Am与E、A显示率均为100%,两者比较差异无统计学意义;中至重度组33例,Em、Am显示率为100%,E、A峰均显示12例,仅显示E峰3例,E、A峰均不显示18例,E、A峰显示率为36%,与Em、Am显示率比较差异有统计学意义(P0.01)。轻度组反流束长度(1.60±0.12)cm,任何反流角度均未出现频率叠加;中至重度组反流束长度分别为(3.69±0.91)cm(E、A峰均显示)、(3.61±0.85)cm(频谱叠加);21例反流角度为23.37°±3.50°时出现频谱叠加,12例反流角度为38.67°±7.30°时,E、A峰均显示。结论对于主动脉瓣中至重度反流、PW显示频谱叠加者,DTI优于PW,能较准确评价左室整体舒张功能,具有一定的临床实用价值。

Evaluation of left ventricular diastolic function in patients with aortic regurgitation by Doppler tissue imaging

Objective To evaluate global diastolic function of left ventricle in patients with aortic regurgitation using Doppler tissue imaging（DTI）. Methods According to the aortic regurgitation degree, forty-two patients were divided into two groups： mild degree group（9 cases）, middle-severe degree group（33 cases）. The length, area and angle of aortic regurgitation were measured by CDFI. The mitral inflow velocity in early period （E）, left atrium contraction inflow velocity （A） and their rate （ E/A ） were measured by pulse wave Doppler（PW ）. The early diastolic wave （ Em ）, late diastolic wave （ Am ） and their rate （ Em/Am ） of the mitral annular movement at post inter-ventricular septum position were measured by DTI. Results In mild degree group, Em/Am 〈1, E/A〈1, the display rate of Em, Am, E and A was 100%, there was no significant difference. In middle-severe degree group, the display rate of Em, Am was 100%, E and A were both displayed in 12 cases, only E was displayed in 3 cases, E and A both were not displayed in 18 cases, the display rate of E and A was 36%. There was obvious difference between Em/Am and E/A （P〈0.01）.The regurgitation length in mild degree group was （1.60＋0.12）cm with no spectrum overlay. The regurgitation length in middle-severe degree group was（ 3.69±0.91 ）cm（ E, A were displayed ） and （3.61±0.85）cm（ spectrum overlay ）.Spectrum overlay was showed in 21 cases when regurgitation angle was at 23.37°±3.50°. E and A both appeared in 12 cases when regurgitation angle was at 38.67°±7.30°. Conclusion DTI is better than PW to assess global diastolic function of left ventricle in patients with middle-severe degree of aortic regurgitation and spectrum aliasing.