多普勒组织成像鉴别陈旧性心肌梗死患者舒张功能假性正常

目的 探讨应用多普勒组织成像（DTI）检测二尖瓣环舒张期运动速度可否鉴别陈旧性心肌梗死（OMI）患者舒张功能假性正常。方法 OMI舒张功能假性正常患者68例，正常对照组50例，应用脉冲多普勒（PWD）分别测量二尖瓣口舒张早期峰值流速（E）、舒张晚期峰值流速（A）、E／A、E峰减速时间（DT）、左室等容舒张时间（IRT）、肺静脉收缩波（S）、舒张波（D）、S／D及心房收缩波（Ar）；转换DTI速度模式，测量左室侧壁缘二尖瓣环舒张早期运动峰值速度（Ea）、舒张晚期运动峰值速度（Aa）并计算Ea／Aa。结果 OMI舒张功能假性正常患者与正常人的年龄和血流频谱E、A、E／A、IRT、D、S／D及二尖瓣环Aa测值比较无显著性差异（P〉0.05），DT缩短和S波降低具有显著性差异（P〈0．05），肺静脉血流Ar较正常人升高，而二尖瓣环Ea及Ea／Aa较比正常人明显减低，具有显著性差异（P〈0．01）。结论 DTI检测二尖瓣环Ea及Ea／Aa比值可鉴别OMI患者舒张功能假性正常。

Identification of Pseudonormal Diastolic Dysfunction in Old Myocardial Infarction with Doppler Tissue Imaging

Objective To identify diastolic dysfunction of pseudonormal pattern of left ventricle in old myocardial infarction by Doppler tissue imaging(DTI).Methods The mitral inflow and pulmonary venous flow were detected in 68 patients with old myocardial infarction with pseudonormal pattern of diastolic dysfunction and 50 normal volunteers.The transmitral peak rapid filling velocity (E),peak atrial filling velocity (A),E/A ratio,at mitral orifice,deceleration time (DT),isovolumic relaxation time (IRT)were measured.The pulmonary venous peak systolic (S) and diastolic(D) flow velocities,S/D ratio,and peak reverse flow velocity due to left atrial systole (Ar) were recorded.At the same time,by activating DTI function,recordings of mitral annular velocities were made with pulsed wave DTI.The peak diastolic velocities of mitral annulus was measured during the early phase of diastole (Ea),the late phase of diastole (Aa),and Ea/Aa ratio.Results There were no differences in E,A,E/A,IRT,D,S/D and Aa between normal subjects and patients with old myocardial infarction(P>0.05).DT were shortened and S were lower in patients than normal subjects (P<0.05).Compared with control group Ar of pulmonary venous flow were higher and Ea,Ea/Aa were lower (P<0.01).Conclusions Ea and Ea/Aa can identify left ventricular diastolic dysfunction of pseudonormal pattern in old myocardial infarction.