多普勒超声E/E'对先天性心脏病患者心室舒张功能的评价  

Evaluation on pulsed Doppler and tissue Doppler-derived septal E / E ' ratio to diastolic function in patients with congenital heart disease

作　　者：薛正杰[1,2] 张智伟[2] 孙凌[2] 李俊杰[2] 

机构地区：[1]南方医科大学,广州510515 [2]广东省心血管病研究所心儿科广东省人民医院(广东省医学科学院),广州510100

出　　处：《岭南心血管病杂志》2015年第2期182-186,250,共6页South China Journal of Cardiovascular Diseases

摘　　要：目的 探索在各种先天性心脏病患者中脉冲多普勒超声二尖瓣舒张早期血流速度峰值（E）与组织多普勒超声二尖瓣环舒张早期运动速度峰值（E’）比值E/E’与左右心导管检查中所测心室舒张末压的相关性,进而探索多普勒超声E/E’对左心室舒张功能的评价价值。方法 总共纳入200例先天性心脏病患者,女120例,男80例,年龄6.5岁（6个月~21岁）。入院后患者均行心导管术,术中测得左心室舒张末压（end-diastolic pressure,EDP）或替代指标（左心房平均压及肺小动脉楔入压）。术前均由同一超声心动图专业人员测得超声心动图参数及组织多普勒（TDI）。这些患者被分成2组,1组为正常双心室患者,其中又分为三亚组：室间隔缺损亚组和房间隔缺损亚组及其他多样先天性心脏病患者的混合亚组;另一组为单心室患者。结果 Pearson线性相关结果显示,在双心室组中,室间隔E/E’和心室EDP有较显著的关联[r=0.65,P〈0.001（双侧）],室间隔E/晚期血流速度峰值（A）与EDP相关性弱（r=0.19,P=0.087）。室间隔E/E’值大于10.85对于左心室EDP大于10 mm Hg（1 mm Hg=0.133 k Pa）灵敏度为77%、特异度为80%。受试者工作曲线下最大面积（area under the curve,AUC）E/E’（AUC=0.87,P〈0.001）而E/A（AUC=0.55,P=0.24）。而在单心室组中,这些参数与EDP没有任何关联。结论在先天性心脏病患儿中,多普勒超声获取的室间隔E/E’比值和左心室EDP有一定的相关性,对左心室充盈压的评价高于其他指标和方法,在对先天性心脏病患儿常规检查中,可能会成为一种新的评价左心室舒张功能的指标。Objectives To investigate whether the ratio of early mitral blood inflow velocity to early diastolic mitral annular velocity（E / E＇） assessed by pulsed tissue Doppler imaging（TDI） was related to ventricular end-diastolic pressure（EDP） in patients with different congenital heart diseases（CHD） undergoing left and right heart catheterization.Methods A total of 200 hospital inpatients [120 females, 80 males, aged 6.5 years（6 months-21 years） ] with different CHD referred for cardiac catheterization underwent simultaneous Doppler interrogation.Invasive measurements of left ventricular EDP and other surrogates such as mean left atrial pressure and pulmonary artery wedge pressure（PAWP） were obtained during catheterization. Doppler signals from the mitral inflow and TDI of the mitral annulus were obtained presurgery. These patients were divided into two groups ： one group consisted of patients with biventricular heart and the other group of patients with univentricular heart. The biventricular heart group was further divided into atrial septal defect（ASD） subgroup, ventricular septal defect（VSD） subgroup and different CHD subgroup. Results According to Pearson＇s test, for the biventricular heart group, a significant positive correlation was found between E / E ＇and EDP（r =0.65, P〈0.001）. EDP correlated rather weakly with E / late mitral blood inflow velocity（A）（r =0.19, P =0.087）. E / E ＇ 〉10.85 had 77 % sensitivity and 80 % specificity for EDP 10 mm Hg（1 mm Hg =0.133 k Pa）. Analysis of these parameters showed that a larger area under the curve（AUC） was found for the ratio of E / E ＇（AUC=0.87, P〈0.001） comparing with E / A（AUC =0.55, P =0.24）. These parameters did not show any relationships to EDP in the univentricular heart group. Conclusions Doppler and tissue Doppler-derived E / E ＇ ratio is related to EDP in a heterogeneous group of patients with CHD, providing better estimates of left ventricular filling pressures than other methods,whic

关 键 词：心脏缺损 先天性 心室舒张功能 左心室舒张末压 室间隔处E/E’ 室间隔处E/A 

分 类 号：R541.1[医药卫生—心血管疾病]