运动负荷E/Em比值评价急性心肌梗死早期左心室充盈压的价值  

Noninvasive estimation of the left ventricular filling pressure by E/Em during exercise in the early stage of acute myocardial infarction

作　　者：白瑾[1] 冯新恒[1] 赵威[1] 王鸿艳[1] 李雪梅[1] 张永珍[1] 高炜[1] 

机构地区：[1]北京大学第三医院心内科,北京100191

出　　处：《北京大学学报（医学版）》2009年第3期328-334,共7页Journal of Peking University:Health Sciences

基　　金：国家"十五"科技攻关项目(2006BAI01A02)资助~~

摘　　要：目的:应用运动负荷组织多普勒超声心动图(tissue Doppler imaging,TDI)测定舒张早期二尖瓣血流速度(E)与二尖瓣环舒张早期运动速度(Em)的比值(E/Em),评价急性心肌梗死(acute myocardial infarction,AMI)后患者早期运动负荷时左心室充盈压(left ventricular filling pressure,LVFP)的变化,并探讨E/Em比值与运动能力的关系。方法:入选2008年3月至8月期间,就诊于北京大学第三医院接受经皮腔内冠状动脉介入治疗(percutaneouscoronary intervention,PCI)、心功能Killip分级Ⅰ～Ⅱ级的初发ST段抬高AMI患者60例,在发病第10～14天进行运动心肺功能评定(应用改良的Bruce平板运动方案,进行症状限制性平板运动耐量试验),在运动前及运动峰值即刻进行TDI检查。选择同期年龄匹配的冠状动脉造影或冠状动脉CT检查结果阴性者30例作为对照组。结果:30例对照组和60例病例组患者均完成运动前后TDI检查。对照组TDI测定运动前、后的E/Em比值无明显变化;病例组中29例(48%,29/60)运动前后E/Em比值均正常,21例(35%,21/60)静息状态下E/Em比值升高,10例(17%,10/60)仅为运动状态下E/Em比值升高。病例组运动前后E/Em比值与代谢当量(metabolic equivalent,METs)均呈显著负相关(r=-0.54和-0.40,P<0.01),运动前后E/Em比值升高组(METs值为4.6±1.6,P<0.01)和仅运动负荷后E/Em比值升高组(METs值为5.8±1.6,P<0.01)较运动前后E/Em比值均正常组(METs值为6.2±1.8)的运动能力明显下降。结论:应用运动负荷TDI测定E/Em比值可以发现AMI早期左心室充盈压增高及运动能力的减低。Objective：To validate a Doppler index of diastolic filling （E/Em） during exercise in the early stage of the patients with acute myocardial infarction, and investigate its association with exercise ca- pacity. Methods： The study enrolled consecutive 60 patients with first ST segment elevation myocardial infarction（STEMI） in Killip I - ]] stage and who underwent percutaneous coronary intervention （PCI） from March 2008 to August 2008 （as study group）, At 10 - 14 days after acute myocardial infarction, Cardiopulmonary Exercising Testing （CPET, Modified Bruce flat treadmill protocol, symptom-limited flat exercise tolerance test） was conducted with Tissue Doppler Imaging （TDI） evaluation at rest and instantly during exercising peak. Doppler index of diastolic filling was also measured at rest and immediately af- ter Cardiopulmonary Exercising Testing in 30 age-matched patients as control whose coronary angiography （CAG） or coronary computed tomography was negative. Results： All patients completed the TDI evaluation at rest and after CPET. There was no significant difference in E/Em measured by TDI in control group at rest and during exercise. In study group, 29 （48% ,29/60） patients had a normal E/Em both at rest and exercise, 21 （35% ,21/60） patients had elevation of E/Em at rest, and 10（ 17% , 10/ 60） patients had elevation of E/Em only during exercise. There was a good negative correlation between E/Era and metabolic equivalent at rest （r = -0. 54, P 〈0. 01 ） and during exercise （r = -0. 40, P 〈 0. 01 ）. The patients which E/Em 〉 10 at rest（METs is 4. 6 ± 1.6, P 〈0. 01 ） and patients who had E/ Em 〉 10 only during exercise （ METs is 5.8 ± 1.6, P 〈 0. 01 ） had a reduced exercise capacity compared with the patients with normal E/Em both at rest and during exercise （ METs is 6.2±1.8）. Conclusion ： The ratio of early diastolic transmitral velocity to early diastolic tissue velocity （E/Em） by the stress ech- ocardiography can be used t

关 键 词：超声心动描记术 压力 心肌梗死 心室功能 左 

分 类 号：R542.22[医药卫生—心血管疾病]