脉冲组织多普勒技术在冠心病定量诊断中的应用

目的 :探讨对冠心病进行无创的、功能上的定量诊断方法。方法 :采用超声心动图脉冲组织多普勒技术(PW -DTI)分析左室壁心肌长轴方向的运动 ,取样于二尖瓣环2点和6个室壁中点测量有关参数 ,制定冠心病PW -DTI诊断标准 :(1)任1个位点收缩期峰速度(Vs)<6cm/s ;(2)至少2点舒张早期峰速度(Ve)<8cm/s ;(3)至少7点e/a<1。具备1条即确诊。以此标准对47例行冠状动脉造影术患者进行冠心病预测诊断 ,以冠状动脉造影为金标准 ,与心电图 (ECG)和二维超声心动图 (2 -DE)对比研究。结果 :PW -DTI诊断冠心病总敏感性(85.19 %)高于2-DE(70.37 % ),与ECG(88.89 % )相当。对单支病变敏感性PW -DTI高于2 -DE(81.82 %vs27.27 % ) ,特异性60.00 % ,与ECG(50.00% )相当 ,低于2 -DE(80.00% )。总准确性 (74.47% )与ECG(72.34 % )及2 -DE(74.47% ) ,差别无统计学意义(P>0.05)。但对病变冠状动脉 (54支 )检出率PW -DTI(61.11% )低于ECG(83.33 % )与2 -DE(81.48% )。结论 :PW -DTI是一项定量诊断冠心病的可靠的无创方法 ,其诊断敏感性可能优于2 -DE。

The Use of Pulsed Tissue Doppler Imaging in Quantitative Diagnosis of Coronary Artery Disease

Objective:To explore the non_invasive,functional and quantitati ve diagnosing method for coronary artery disease.Methods:Analysis of longitudinal left ventricular wall motion was performed with pulsed_wave tissue Doppler imaging(PW_DTI).Eight sample sites were selected at septal(inner)and lateral(outer)mitral annulus and mid_points of six left ventricular walls.The criterion of PW_DTI for determining coronary artery disease(CAD)was stipulated as one of the3points:(1)Vs was less than6cm/s in any one site.(2)Ve was less than8cm/s in at least2sites.(3)e/a was less than1in at least7sites.Forty_seven patients underwent coronary angiography,and the results were compared with ECG and2_DE.Results:The sensitivity of PW-DTI for detecting CAD was85.19%,and there was no significant difference among three methods.The specificity was60.00%,which was similar to ECG(50.00%)and lower than2_DE(80.00%).The total accuracy was74.47%,and there was no significant differnce among three methods(72.34%for ECG and74.47%for2_DE).The detective rate of single vessel in PW_DTI(81.82%)was higher than that in2_DE(27.27%).The detective rate of coronary artery disease in PW_DTI(61.11%)was lower than that in ECG(83.33%).Conclusion:PW_DTI is a new reliable and non_invasive technique for quantitatively diagnosing CAD,and its sensitivity is probably superior to2_DE.