Kim W H, Otsuji Y, Seward J B, Tei C
First Department of Internal Medicine, Faculty of Medicine, Kagoshima University, Japan.
Jpn Heart J. 1999 Mar;40(2):145-54. doi: 10.1536/jhj.40.145.
Although the effects of right ventricular (RV) volume and pressure overload (RVVO and RVPO) on ventricular septal motion are different, the differential effect on left ventricular (LV) function is still controversial. The Doppler-derived index (Tei index) combining systolic and diastolic ventricular function, defined as the sum of isovolumetric contraction time (ICT) and isovolumetric relaxation time (IRT) divided by ejection time (ET), has been demonstrated to be a useful index to estimate LV function and to predict the prognosis of patients with congestive heart failure. This study was designed to evaluate the differential effects of RVVO and RVPO on LV function using the Tei index. Study patients consisted of 26 age-matched normal subjects, 22 patients with atrial septal defect (ASD) with normal or borderline RV pressure and 25 with primary pulmonary hypertension (PPH). All subjects had normal LV ejection fractions measured with 2-dimensional echocardiogram using biplane Simpson's method (61 +/- 4 vs 61 +/- 4 vs 63 +/- 8%, normal vs ASD vs PPH). Tei index was easily obtained in all subjects from transthoracic Doppler echocardiogram of LV inflow and outflow. Patients with ASD had normal ICT, IRT and ET, resulting in normal Tei index, however, patients with PPH had significantly prolonged ICT and IRT with shortened ET, resulting in a significant increase in Tei index (0.38 +/- 0.04 vs 0.36 +/- 0.03 vs 0.61 +/- 0.22, p < 0.001). Although RVVO due to ASD has no significant effects on LV function, RVPO due to PPH can adversely affect LV function. The Tei index is a simple and sensitive measure to assess LV function caused by RVVO or RVPO.
尽管右心室容量和压力超负荷（RVVO和RVPO）对室间隔运动的影响不同，但对左心室（LV）功能的差异影响仍存在争议。结合收缩期和舒张期心室功能的多普勒衍生指数（Tei指数），定义为等容收缩时间（ICT）与等容舒张时间（IRT）之和除以射血时间（ET），已被证明是评估左心室功能和预测充血性心力衰竭患者预后的有用指标。本研究旨在使用Tei指数评估RVVO和RVPO对左心室功能的差异影响。研究对象包括26名年龄匹配的正常受试者、22名房间隔缺损（ASD）且右心室压力正常或临界的患者以及25名原发性肺动脉高压（PPH）患者。所有受试者均使用双平面辛普森法通过二维超声心动图测量左心室射血分数正常（正常组vs ASD组vs PPH组：61±4% vs 61±4% vs 63±8%）。通过经胸多普勒超声心动图测量左心室流入和流出，所有受试者均能轻松获得Tei指数。ASD患者的ICT、IRT和ET正常，Tei指数也正常，然而，PPH患者的ICT和IRT显著延长，ET缩短，导致Tei指数显著升高（0.38±0.04 vs 0.36±0.03 vs 0.61±0.22，p<0.001）。尽管ASD导致的RVVO对左心室功能无显著影响，但PPH导致的RVPO会对左心室功能产生不利影响。Tei指数是评估RVVO或RVPO引起的左心室功能的一种简单而敏感的方法。
