Yasuoka K, Harada K, Toyono M, Tamura M, Yamamoto F
Departments of Pediatrics and Cardiovascular Surgery, Akita University School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan.
Pediatr Cardiol. 2004 Mar-Apr;25(2):131-6. doi: 10.1007/s00246-003-0514-3. Epub 2003 Dec 4.
The myocardial performance index (Tei index) determined by the pulsed Doppler method is a simple and noninvasive measurement for assessing global right ventricular (RV) function. This index can also be obtained by tissue Doppler imaging (TDI). The effects of significant pulmonary regurgitation (PR) on the determination of the Tei index by these two methods have not been investigated. We examined 15 patients (6.3 +/- 2.2 years) with significant PR after repair of tetralogy of Fallot (TOF) and 24 age-matched healthy children. Myocardial wall motion velocities at the tricuspid annulus were assessed during systole (Sa), early diastole (Ea), and late diastole (Aa) from a four-chamber view. Pulsed Doppler-Tei index and TDI-Tei index were measured as reported previously. The Tei index obtained by the pulsed Doppler method in TOF patients did not differ from that in normal children (0.30 +/- 0. 12 vs 0.32 +/- 0.07, p = not significant). TDI showed that TOF patients had significantly decreased Ea, Aa, and Sa velocities compared to those of normal children. Both isovolumic contraction time and isovolumic relaxation time in TOF patients were significantly longer than those in normal children (88 +/- 18 vs 62 +/- 23 msec and 46 +/- 11 vs 21 +/- 12 msec, respectively; p < 0.0001), although the duration of Sa did not differ between the two groups. Consequently, the Tei index as measured by TDI was significantly greater in TOF patients than in normal children (0.48 +/- 0.07 vs 0.30 +/- 0.07, p < 0.0001). The Tei index measured by the pulsed Doppler method is limited in its ability to assess RV function in patients with significant PR. However, the Tei index determined by TDI is a sensitive indicator of RV function in these patients, and it appears to be a promising new means of assessing global RV function in patients with significant PR.
采用脉冲多普勒法测定的心肌性能指数（Tei指数）是一种用于评估右心室整体功能的简单无创测量方法。该指数也可通过组织多普勒成像（TDI）获得。严重肺反流（PR）对这两种方法测定Tei指数的影响尚未得到研究。我们检查了15例法洛四联症（TOF）修复术后有严重PR的患者（6.3±2.2岁）以及24名年龄匹配的健康儿童。从四腔心切面评估三尖瓣环处心肌壁在收缩期（Sa）、舒张早期（Ea）和舒张晚期（Aa）的运动速度。按照之前报道的方法测量脉冲多普勒-Te指数和TDI-Te指数。TOF患者通过脉冲多普勒法获得的Tei指数与正常儿童的Tei指数无差异（0.30±0.12对0.32±0.07，p无统计学意义）。TDI显示，与正常儿童相比，TOF患者的Ea、Aa和Sa速度显著降低。TOF患者的等容收缩时间和等容舒张时间均显著长于正常儿童（分别为88±18对62±23毫秒和46±11对21±12毫秒；p<0.0001），尽管两组之间的Sa持续时间无差异。因此，TDI测量的TOF患者的Tei指数显著高于正常儿童（0.48±0.07对0.30±0.07，p<0.0001）。脉冲多普勒法测量的Tei指数在评估严重PR患者右心室功能方面能力有限。然而，TDI测定的Tei指数是这些患者右心室功能的敏感指标，似乎是评估严重PR患者右心室整体功能的一种有前景的新方法。
