双频谱多普勒同步测量T E-e’在评估左室舒张功能中的价值  

Estimating Left Ventricular Diastolic Function through Simultaneous Measurement of T E-e'using Dual-Doppler

作　　者：贺勇[1] 李娅姣[1] 李晨[1] 刘丹[1] 唐红[1] 饶莉[1] 

机构地区：[1]四川大学华西医院心内科,成都610041

出　　处：《四川大学学报（医学版）》2015年第4期597-601,共5页Journal of Sichuan University(Medical Sciences)

基　　金：成都市科技计划项目(No.10GGYB076SF-023);四川省科技厅科技支撑计划项目(No.2012SZ0028)资助

摘　　要：目的评估双频谱多普勒同步测量二尖瓣前向血流E峰和二尖瓣环组织多普勒e’峰的起始时间差（T E-e’）在无创估测左室舒张末压（LVEDP）和左室舒张功能不全中的价值。方法纳入NYHA心功能≥Ⅱ级,且左室射血分数（LVEF）≥50%的疑诊冠心病拟行冠脉造影患者78例,冠脉造影时行左心导管检查,根据LVEDP分为舒张功能不全组（LVEDP≥15mmHg,1mmHg=0.133kPa）和对照组（LVEDP〈15mmHg）。行常规心脏超声及双频谱多普勒超声测量T E-e’,并比较T E-e’。结果 78例患者舒张功能不全组48例,对照组30例。双频谱多普勒方法测量的同步T E-e’在舒张功能不全组高于对照组〔（24.1±31.4）ms vs.（8.1±23.3）ms,P=0.019〕,且与LVEDP呈线性关系（r=0.424,P〈0.001）。ROC曲线示T E-e’=25ms时,同步T E-e’诊断左室舒张功能不全的敏感性和特异性分别为56.3%和76.7%。传统方法测量T E-e’操作者间重复测量的可信限为-37.7-34.9ms,采用双频谱多普勒方法同步测量T E-e’可提高重复性（重复测量可信限-28.0-27.3 ms）。结论同步T E-e’在左室舒张功能不全的患者中延长,且与LVEDP呈正相关。与传统方法相比,双频谱多普勒方法可提高T E-e’测量的重复性。Objective Time interval between the onset of E and e＇（T E-e＇）was applied as a non-invasive index for estimating left ventricular diastolic function.The T E-e＇was measured simultaneously using dualDoppler.Methods Dual-Doppler method was established,which allowed simultaneous recording and display of E and e＇,thus facilitating the measuring of T E-e＇.Seventy-eight patients with suspected coronary artery disease,classⅡ or above NYHA heart function,and ≥50% left ventricle ejection fraction（LVEF）were recruited.The patients were given conventional echocardiography and dual-Doppler echocardiography.Left ventricle end diastolic pressure（LVEDP）of the patients was measured during left heart catheterization.The patients were divided into diastolic dysfunction group（n=48）and control group（n=30）according to their LVEDP.Results The patients with diastolic dysfunction had higher T E-e＇〔（24.1±31.4）ms vs.the controls（8.1±23.3）ms,P=0.019〕.Significant linear correlation was found between T E-e＇and LVEDP（r=0.424,P〈 0.001）.The receiver operating characteristic（ROC）curve showed a sensitivity of 56.3% and a specificity of 76.7%for T E-e＇detecting elevated LVEDP.T E-e＇estimated by dual-Doppler had better inter-observer reliability（limit of agreement：-28.0-27.3ms）compared with the conventional method（limit of agreement：-37.7-34.9ms）.Conclusion Simultaneous T Ee＇estimated by dual-Doppler has improved reliability,which is correlated with LVEDP.Patients with diastolic dysfunction have greater T E-e＇.

关 键 词：舒张功能不全 左室舒张末压 双频谱多普勒 二尖瓣前向血流E峰和二尖瓣环组织多普勒e’峰起始时间差(T E-e’) 

分 类 号：R541.6[医药卫生—心血管疾病]