多普勒组织成像评价扩张型心肌病患者左心室舒张功能的价值

目的探讨多普勒组织成像评价扩张性心肌病患者左心室舒张功能的临床价值。方法应用多普勒组织成像检测了33例扩张型心肌病（DCM）患者及30例正常人左心室前间隔、后壁、前壁、下壁、后间隔和侧壁近二尖瓣环处的心肌舒张早期波（E’）、晚期波（A’）速度、速度时间积分等。测量了左心室舒张末内径（LVEDd）、容积（LVEDV）及二尖瓣口舒张早期充盈速度（ME）、减速时间（MDT），房缩期充盈速度（MA）等，应用改良Simpson’s法测量左心室射血分数（LVEF）等。结果与对照组相比，DCM患者LVEDd、LVEDV显著增大（P〈0．01），LVEF降低（P〈0．01），ME、MDT、MA两组差异无统计学意义（P〉0．05）。两组左心室基底部后壁心肌舒张晚期速度、速度时间积分、前壁舒张晚期速度时间积分差异无统计学意义（P〉0．05），余各壁心肌舒张早、晚期速度、速度时间积分两组差异有统计学意义（P〈0．05）。结论DCM患者左心室基底部各壁心肌舒张早、晚期速度、速度时间积分均有明显减低，表明左心室舒张功能存在一定程度的减退，而二尖瓣口血流多普勒频谱无明显改变，提示DTI较传统多普勒血流成像法能更好评价左心室舒张功能改变。

Clinical value on the evaluation of diastolic function in patients with dilated cardiomyopathy by Doppler tissue imaging

Objective To detect the clinical value on the evaluation of diastolic function in patients with dilated cardiomyopathy（DCM） by Doppler tissue imaging（DTI）. Methods The left ventricular basal walls＇ DTI were examined in 33 patients with DCM and 30 normal people. The early and late myocardial diastolic velocities, velocity time integrals, left ventricular end diastolic diameter（ LVEDd）, end diastolic volume（LVEDV） ,mitral early filling velocity（ ME）, deceleration time （MDT） , late filling velocity （MA） were measured. Left ventricular ejection fraction （LVEF） was calculated by modified Simpson＇ s method. Results Compared with control group, LVEDd and LVEDV in patients with DCM were significantly increased（ P 〈0.01 ）, LVEF was decreased （ P 〈0.01 ）. There was no significant difference between the two groups for ME, MDT, MA （ P 〉 0.05 ）. There were significant differences between two groups for basal left ventricular walls＇ early diastolic velocities, late diastolic velocities, velocity time integrals（ P 〈 0.01 ） except basal posterior wall＇s late diastolic velocity, velocity time integral and basal anterior wall＇ s late diastolic velocity time integral （ P 〉 0.05）. Conclusions The significant decreases of basal left ventricular walls＇ myocardial early and late diastolic velocities, velocity time integrals in patients with DCM meant impairment of left ventricular diastolic function, and that there are no significant changes of mitral filling velocities between two groups indicated that DTI is better for evaluation of left ventricnlar diastolic function than conventional Doppler flow imaging.