组织多普勒成像技术评价冠心病心肌梗死后左室整体功能  

Assessment of left ventricular function using tissue Doppler imaging in patients with myocardial infarction

作　　者：褚晓雯[1] 王枫[1] 闫赋琴[2] 

机构地区：[1]首都医科大学教学医院北京电力医院心内科,100073 [2]武警总医院药剂科,北京100039

出　　处：《武警医学》2011年第11期952-954,957,共4页Medical Journal of the Chinese People's Armed Police Force

基　　金：国家科技部973课题资助(G2000057006)

摘　　要：目的应用超声心动图对冠心病心肌梗死患者进行检测,寻找与左室功能相关性良好的指标以利于临床评估。方法对经临床及冠状动脉造影确诊的心肌梗死(1～6个月)患者68例行多普勒超声心动图检查。根据其二尖瓣口血流频谱形态将患者分为3组:左室松弛性减低组、假性正常化组、限制性充盈组;又根据心脏射血分数(ejection fraction,EF)值将患者分为两组:EF≥50%,EF<50%,将各多普勒超声心动图参数在各组对比分析。结果随着心脏舒张功能障碍的进展,运用组织多普勒技术(TDI)测得的二尖瓣环舒张早期峰值速度(Ea)及其与舒张晚期峰值速度(Aa)的比值Ea/Aa降低(P<0.01),其差别尤其表现在对照组与左室松弛性减低组及其与假性正常化组之间(P<0.01)。在正常对照组、冠心病心肌梗死EF正常组及冠心病心肌梗死EF减低组TDI测得的二尖瓣环收缩期峰值速度Sa、Ea及Ea/Aa比值呈逐渐降低趋势(P<0.01)。而且Spearman相关分析表明:Ea值及Ea/Aa比值与左室舒张功能障碍分级相关性良好,Sa与EF值相关性良好。结论冠心病心肌梗死患者出现左室舒张功能障碍常先于左室收缩功能障碍,TDI测得的Ea及Ea/Aa比值可用于鉴别左室舒张功能的假性正常化;TDI测得的Sa可作为评估冠心病心肌梗死患者左室收缩功能的重要参数。Objective To examine patients with myocardial infarction to obtain variables closely correlated with the left ventricular function. Methods Doppler echocardiography was performed in 68 patients with myocardial infarction in various stages of diastolic and systolic dysfunction and 52 normal controls. The patients were divided into three groups according to their mitral flow spectrum, （ 1 ） delayed left ventricular relaxation, （ 2 ） pseudo - normal left ventricular filling, （ 3 ） restrictive left ventricular filling. They were divided again into two groups according their ejection fraction （EF） ; （ 1 ） EF 〉 50% and ; （2） EF 〈 50%. Results With deterioration of the left ventricular diastolic dysfunction, significant difference was found in the Ea and Ea/Aa ratio （ P 〈 0.01 ） by Doppler tissue imaging , especially between the group of healthy controls and the group of delayed left ventricular relaxation （ P 〈 0.01 ） and between the group of healthy controls and the group of pseudo normal left ventricular filling （P 〈 0.01 ）. The Sa, Ea and Ea/Aa ratio showed gradual decrease in the three groups （ P 〈 0.01 ）. Spearman correlation analysis showed that Ea and Ea/Aa ratio was closely correlated with left ventricu｜ar diastolic function, and Sa with EF. Conclusions The left ventricular diastolic dysfunction usually occurs before the left ventricular systolic dysfunction. Ea and Ea/Aa ratio can be used to identify pseudo - normal left ventricular filling. Sa can assess left ventrieular systolic function in patients with myocardial infarction.

关 键 词：组织多普勒成像 心肌梗死 左室舒张功能 左室收缩功能 

分 类 号：R542.22[医药卫生—心血管疾病]