组织多普勒联合Tei指数评价右室梗死患者右心功能

目的探讨应用多普勒组织成像(DTI)技术及Tei指数评价右室梗死患者的右心功能。方法急性下壁心肌梗死51例,于心尖四腔观切面以DTI速度模式录取三尖瓣游离壁侧瓣环、室间隔侧瓣环和游离壁中段收缩期、舒张早、晚期峰值运动速度(Sm、Em、Am)及Em/Am;以脉冲多普勒记录三尖瓣关闭至再次开放间期,并于胸骨旁短轴切面记录射血时间,计算右心Tei指数。结果右室心肌梗死组于三尖瓣游离壁侧瓣环及右室游离壁中部Sm、Em较无右室心肌梗死及正常对照组明显减低游离壁侧瓣环Sm(70±20)cm/s比(87±19)cm/s和(106±21)cm/s,P<001;游离壁侧瓣环Em(63±19)cm/s比(79±18)cm/s和(96±19)cm/s;P<001;游离壁中段Sm(64±19)cm/s比(80±19)cm/s和(94±20)cm/s,P<005;游离壁中段Em(61±20)cm/s比(76±20)cm/s和(92±23)cm/s;P<005];右心Tei指数亦较其他两组普遍增高(065±019比040±015和026±010;P<001)。结论DTI技术检测三尖瓣游离壁侧瓣环及右室游离壁中段运动速度及右心Tei指数可无创、迅速评价右室心肌梗死患者右心室功能。

Evaluation of right ventricular function by tissue Doppler echocardiography and Tei index in right ventricular myocardial infarction

OBJECTIVE: With tissue Doppler imaging and right ventricular Tei index, right ventricular function in patients with right ventricular myocardial infarction (RVMI) was assessed. METHOD: 51 patients admitted to coronary care units and diagnosed as acute inferior myocardial infarction were further studied with the ECG criterion of ST segment elevation >or= 1mm in V(4R) to establish the diagnosis of RVMI. 23 patients were thus diagnosed as RVMI and 28 patients not. 20 healthy subjects served as controls. Clinical and echocardiography index were recorded. Peak systolic and peak early and late diastolic velocities (Sm, Em, Am) and Em/Am were acquired from the apical four-chamber view at the lateralside of tricuspid annulus, the septal side of the tricuspid annulus and the RV free mid-wall using DTI. Interval between tricuspid closing and reopening and ejection time (ET) from parasternal short-axis view were recorded by pulse-wave Doppler. RV Tei index was calculated. RESULTS: Sm and Em at the lateral side of tricuspid annulus and the RV free mid-wall reduced significantly in patients with RVMI as compared with those without RVMI and healthy individuals (Sm at the lateral (7.0 +/- 2.0) cm/s vs (8.7 +/- 1.9) cm/s and (10.6 +/- 2.1) cm/s, P < 0.01; Em at the lateral (6.3 +/- 1.9) cm/s vs (7.9 +/- 1.8) cm/s and (9.6 +/- 1.9) cm/s, P < 0.01; Sm at the RV free mid-wall (6.4 +/- 1.9) cm/s vs (8.0 +/- 1.9) cm/s and (9.4 +/- 2.0) cm/s, P < 0.05; Em at the RV free mid-wall (6.1 +/- 2.0) cm/s vs (7.6 +/- 2.0) cm/s and (9.2 +/- 2.3) cm/s, P < 0.05). RV Tei index in patients with RVMI also increased as compared with that in the other two groups (0.65 +/- 0.19 vs 0.40 +/- 0.15 and 0.26 +/- 0.10; P < 0.01). CONCLUSIONS: The evaluation of velocities at the lateral side of tricuspid annulus and the RV free mid-wall using DTI and RV Tei index provides a noninvasive and rapid method for assessing right ventricular function in patients with RVMI.