Baykan Merih, Yilmaz Remzi, Celik Sükrü, Orem Cihan, Kaplan Sahin, Erdol Cevdet
Department of Cardiology, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey.
J Am Soc Echocardiogr. 2003 Oct;16(10):1024-30. doi: 10.1016/S0894-7317(03)00552-2.
The aim of this study was assessment of left ventricular (LV) systolic and diastolic function by pulsed wave Doppler tissue imaging (DTI) in patients with or without preinfarction angina in acute myocardial infarction.
We prospectively evaluated 31 consecutive patients (4 women, 27 men; age 58 +/- 10 years) with a first acute myocardial infarction. LV systolic and diastolic function was assessed by classic methods and DTI on the third day during acute myocardial infarction. Patients were divided into 2 groups according to the presence (group 1; n = 10) or absence (group 2; n = 21) of preinfarction angina. Mitral inflow velocities and early diastolic mitral annular velocity (Em), late diastolic mitral annular velocity (Am), peak systolic mitral annular velocity, Em/Am, the ratio of early diastolic mitral inflow velocity (E) to Em, and myocardial performance index were calculated by DTI.
Group 1 had significantly higher Em and Em/Am than group 2 (11.3 +/- 3.34 cm/s vs 7.4 +/- 2.07 cm/s, P <.0001; 1.01 +/- 0.38 cm/s vs 0.6 +/- 0.2 cm/s, P =.001, respectively). The E/Em ratio and myocardial performance index were significantly lower in group 1 than in group 2 (5.1 +/- 2.92 vs 8.10 +/- 3.15, P=.018; 0.49 +/- 0.15 vs 0.65 +/- 0.24, P =.042, respectively). Wall-motion score index was lower in those with preinfarction angina than in those without (1.6 +/- 0.36 vs 1.9 +/- 0.39; P =.04, respectively). Peak systolic mitral annular velocity and Am were not statistically different between groups (9.4 +/- 1.84 vs 8.3 +/- 2.03, P =.172; 11.7 +/- 3.07 vs 12.1 +/- 3.34, P =.72, respectively). There were no significant differences between the 2 groups regarding transmitral E velocity, atrial contraction mitral inflow velocity (A), E/A ratio, isovolumetric relaxation time, and deceleration time of the mitral E wave (P =.91, P =.08, P =.58, P =.81, and P =.71, respectively).
LV diastolic function was better in patients with preinfarction angina than in patients without. This condition could not be detected by conventional mitral inflow Doppler velocities, but could be detected by DTI. This preliminary evidence shows that DTI is better than conventional mitral Doppler indices in the assessment of a favorable LV diastolic function in patients with preinfarction angina.
本研究旨在通过脉冲波多普勒组织成像（DTI）评估急性心肌梗死患者有无梗死前心绞痛时的左心室（LV）收缩和舒张功能。
我们前瞻性评估了31例连续的首次急性心肌梗死患者（4例女性，27例男性；年龄58±10岁）。在急性心肌梗死第三天，通过经典方法和DTI评估LV收缩和舒张功能。根据有无梗死前心绞痛将患者分为2组（1组；n = 10）或无（2组；n = 21）。通过DTI计算二尖瓣流入速度、舒张早期二尖瓣环速度（Em）、舒张晚期二尖瓣环速度（Am）、收缩期二尖瓣环峰值速度、Em/Am、舒张早期二尖瓣流入速度（E）与Em的比值以及心肌性能指数。
1组的Em和Em/Am显著高于2组（分别为11.3±3.34 cm/s对7.4±2.07 cm/s，P <.0001；1.01±0.38 cm/s对0.6±0.2 cm/s，P =.001）。1组的E/Em比值和心肌性能指数显著低于2组（分别为5.1±2.92对8.10±3.15，P =.018；0.49±0.15对0.65±0.24，P =.042）。梗死前心绞痛患者的壁运动评分指数低于无梗死前心绞痛患者（分别为1.6±0.36对1.9±0.39；P =.04）。两组之间的收缩期二尖瓣环峰值速度和Am无统计学差异（分别为9.4±1.84对8.3±2.03，P =.172；11.7±3.07对12.1±3.34，P =.72）。两组之间在二尖瓣E速度、心房收缩二尖瓣流入速度（A）、E/A比值、等容舒张时间和二尖瓣E波减速时间方面无显著差异（分别为P =.91、P =.08、P =.58、P =.81和P =.71）。
梗死前心绞痛患者的LV舒张功能优于无梗死前心绞痛患者。这种情况不能通过传统的二尖瓣流入多普勒速度检测到，但可以通过DTI检测到。这一初步证据表明，在评估梗死前心绞痛患者的良好LV舒张功能方面，DTI优于传统的二尖瓣多普勒指标。
