慢性左心室收缩性心力衰竭患者的舒张功能评价

目的评价慢性左心室收缩功能不全患者的左心室舒张功能,并提出易于临床操作的简便评价方法。方法对2006年9月至12月在我科住院或门诊随访的左心室收缩功能减退的46例心力衰竭患者的超声心动图、明尼苏达心力衰竭生活质量评分、6 min步行试验、纽约心脏病学会(NYHA)心功能分级情况及相关病史进行统计分析。参照美国超声心动图学会推荐的舒张功能分级,对左心室等容舒张时间、二尖瓣E／A比值、E峰的减速时间(DT)、E／Em比值、肺静脉S／D比值和Ar峰值进行综合评定,作出相应舒张功能分级。结果46例左心室收缩性心功能不全的患者均存在不同程度的舒张功能异常,其中30．4％的患者为舒张功能1级,56．5％为2级,13．0％为3级。不同舒张功能分级患者的等容舒张时间、二尖瓣E／A比值、E／Em比值、肺静脉S／D比值、左心房内径和面积、左心室舒张末期内径和容积、二尖瓣E峰和A峰、组织多普勒超声检查二尖瓣环Am、二尖瓣血流E峰的速度时间积分及肺静脉D峰的差异均有统计学意义(P值分别<0．01、0．05);而舒张功能分级与生活质量评分、6 min步行距离和NYHA心功能分级无关。结论慢性左心室收缩功能不全往往合并不同程度的舒张功能异常,但舒张功能异常的程度与临床表现无明显相关性(P值均>0．05)。超声心动图可全面评价慢性心力衰竭患者的收缩和舒张功能,并进行分级。

Evaluation of diastolic dysfunction in patients with chronic heart failure by Doppler echocardiography

Objective To evaluate the diastolic dysfunction in patients with chronic left ventricular failure by Doppler echocardiography and try to pose a convenient method of evaluating the diastolic function. Methods Forty-six patients with chronic heart failure from Sep. to Dec. 2006 underwent assessments via Doppler echocardiography. Minnesota heart failure score of quality of life, six-minute walking test and New York Heart Association (NYHA) grade of heart failure. According to the diastolic function classification recommended by American Society of Echocardiography, the diastolic dysfunction is classified into 0-3 grades by comprehensive parameters of isovolu-metric relaxation time, mitral E/A ratio, E wave deceleration time, E/Em ratio, pulmonary vein S/D ratio and the peak value of Ar. Results All the 46 patients had diastolic dysfunction, including 30. 4% of grade 1, 56. 5% of grade 2 and 13. 0% of grade 3. Doppler's parameters, including left ventricular isovolumetric relaxation time, mitral valve E/A ratio, E/Em ratio and pulmonary vein S/D ratio, left atrial diameter, left atrial area, left ventricular end diastolic volume and diameter, mitral valve E wave and A wave, tissue Dopplar imaging (TDD mitral valve Am, velocity-time integral (VTI) of E wave and D wave of pulmonary vein showed significant differences among different diastolic dysfunction grades (P< 0. 01, 0.05). There were no correlation among score of quality of life, six-minute walking distance or NYHA grade of diastolic dysfunction. Conclusions Diastolic dysfunction is present in varying degrees in chronic heart failure, but the diastolic dysfunction is not related to patients' clinical manifestations. Doppler echocardiography served as a noninvasive method can be used to evaluate the diastolic function comprehensively.