多普勒组织成像技术评价充血性心力衰竭患者左室功能改变

目的:采用组织多普勒技术(DTI)观察充血性心力衰竭(心衰)患者心肌收缩功能指标与NYHA心功能分级的关系及其治疗前后左室收缩、舒张功能的改变。方法:以34例心衰患者为心衰组,34例正常人作为对照组,采用DTI测量二尖瓣环的后间隔和侧壁处(心尖四腔切面观)及前壁和下壁处(心尖二腔切面观)4个位点的收缩期、舒张早期和舒张晚期运动速度峰值(分别为Sa,Ea,Aa)。计算Ea/Sa、二尖瓣环4个位点平均收缩速度VMS。结果:二尖瓣环侧壁位点的收缩速度与NYHA心功能分级相关性较好(rs=-0.65,P<0.0001),而VMS与NYHA心功能分级相关性最好(rs=-0.69,P<0.0001)。心衰组治疗前4个位点的Sa和Ea均显著低于正常组(P<0.001),Ea/Sa较正常组增高(P<0.01)。心衰组治疗后4个位点的Sa和Ea均显著高于治疗前(P<0.001),Ea/Sa较治疗前减低(P<0.01)。结论:DTI可定量分析心衰患者左室壁的舒缩功能及动态变化。二尖瓣环4个位点平均收缩峰值速度VMS与NYHA心功能分级关系最密切。

Evaluating left ventricular function in congestive heart failure before and after treatment assessed by Doppler tissue imaging

Objective:To analyse the correlation of parameters between left ventricular systolic function,functional class,and the systolic and diastolic function of left ventricle before and after treatment by Doppler tissue imaging(DTI).Methods:Thirty-four consecutive patients with a clinical diagnosis of congestive heart failure were studied by DTI.Four sites at mitral annuli were selected corresponding to the septal,lateral,anterior and inferior walls of the ventrical from apical 4-and 2-chamber views.We detected wall motion of mitral valve annulus and recorded DTI indexes included the peak systolic velocities(Sa),the peak early and late diastolic velocities(Ea and Aa).Sa/Ea and VMS were calculated.Thirty-four normal subjects were selected as control group.Results:Sa derived from the lateral site of mitral annulus from apical four-chamber view correlated well with functional class(rs=-0.65,P<0.0001),the 4-site average velocities of mitral annulus correlated better with functional class(rs=-0.69,P<0.0001).Compared with healthy controls,Sa and Ea of all 4 sites were significantly decreased(P<0.001),Ea/Sa significantly increased(P<0.01).After treatment,Sa and Ea of all 4 sites were significantly increased(P<0.001),Ea/Sa significantly decreased(P<0.01).Conclusions:Left ventricular systolic and diastolic function could be quantitatively analyzed by DTI,there are more close correlation between the 4-site average velocities of mitral annulus VMS and NYHA functional class.