Lengyel Mária, Nagy András, Zorándi Agnes
Gottsegen György Országos Kardiológiai Intézet, Budapest.
Orv Hetil. 2002 Feb 17;143(7):333-9.
Diastolic dysfunction and elevated filling pressure have important role in heart failure. Traditional Doppler echocardiography (DE) however is of limited value in the measurement of these variables. The objective of this study was the evaluation of a new technique, the pulsed tissue Doppler echocardiography of the lateral mitral anulus (PTDI) in diastolic function. 96 consecutive patients were included into the study who were in sinus rhythm, mitral valve disease was excluded and ejection fraction was either > or = 50% (50 patients) or < or = 40% (46 patients). DE technique was used to measure mitral E, A velocity, deceleration time (DT). Myocardial early diastolic (Ea), late diastolic (Aa) velocities were measured at the lateral mitral anulus by PTDI, and E/A, Ea/Aa, E/Ea ratios were calculated. Based on accepted DE criteria of diastolic dysfunction there were 19 normal subjects, 18 patients had abnormal relaxation, 8 had pseudonormalization pattern and 12 had restrictive dysfunction, the rest of patients did not fulfill these criteria.
PDTI indicated an association of diastolic dysfunction to systolic dysfunction, which could not be shown by DE. Myocardial Ea velocity was age-dependent only in patients with good systolic function, and it was less than 15 cm/s in all types of diastolic dysfunction. E/Ea ratio over 8 indicated elevated filling pressure, but it was related to E/A ratio only in cases of good systolic function. Importantly one third of cases could be classified into diastolic dysfunction patterns only using tissue Doppler.
Myocardial diastolic velocities can be easily measured by pulsed tissue Doppler technique at the lateral mitral anulus. Decreased early diastolic tissue velocity indicates diastolic dysfunction independently of its type, and it is generally associated to systolic dysfunction, independently of age. Pseudonormalization is defined as the combination of normal mitral inflow and decreased tissue diastolic velocity.
舒张功能障碍和升高的充盈压在心力衰竭中起重要作用。然而，传统的多普勒超声心动图（DE）在测量这些变量方面价值有限。本研究的目的是评估一种新技术，即二尖瓣外侧环脉冲组织多普勒超声心动图（PTDI）在舒张功能方面的应用。连续96例患者纳入研究，这些患者为窦性心律，排除二尖瓣疾病，射血分数≥50%（50例）或≤40%（46例）。采用DE技术测量二尖瓣E、A速度、减速时间（DT）。通过PTDI测量二尖瓣外侧环的心肌舒张早期（Ea）、舒张晚期（Aa）速度，并计算E/A、Ea/Aa、E/Ea比值。根据公认的舒张功能障碍DE标准，有19例正常受试者，18例患者有舒张功能异常松弛，8例有假性正常化模式，12例有限制性舒张功能障碍，其余患者不符合这些标准。
PTDI显示舒张功能障碍与收缩功能障碍有关，而DE未显示这一点。心肌Ea速度仅在收缩功能良好的患者中与年龄有关，在所有类型的舒张功能障碍中均小于15cm/s。E/Ea比值超过8表明充盈压升高，但仅在收缩功能良好的情况下与E/A比值有关。重要的是，仅使用组织多普勒，三分之一的病例可归类为舒张功能障碍模式。
通过二尖瓣外侧环脉冲组织多普勒技术可轻松测量心肌舒张速度。舒张早期组织速度降低表明舒张功能障碍，与其类型无关，且通常与收缩功能障碍有关，与年龄无关。假性正常化定义为正常二尖瓣血流与降低的组织舒张速度的组合。
