用Tei指数对急性心肌梗死患者血流动力学受损进行无创评估。

Noninvasive estimation of impaired hemodynamics for patients with acute myocardial infarction by Tei index.

作者信息

Takasaki Kunitsugu, Otsuji Yutaka, Yoshifuku Shiro, Kuwahara Eiji, Yuasa Toshinori, Abd-El-Rahim Alaa Eldin Rabea, Matsukida Keiko, Kumanohoso Toshiro, Toyonaga Kouichi, Kisanuki Akira, Minagoe Shinichi, Tei Chuwa

机构信息

First Department of Internal Medicine, Kagoshima University School of Medicine, and Division of Cardiology, Kagoshima City Hospital, Sakuragaoka, Japan.

出版信息

J Am Soc Echocardiogr. 2004 Jun;17(6):615-21. doi: 10.1016/j.echo.2004.02.020.

DOI:10.1016/j.echo.2004.02.020

PMID:15163931

Abstract

BACKGROUND

Tei index, defined as the sum of isovolumic contraction and relaxation times divided by ejection time, has been proposed to express global left ventricular function. For patients with acute myocardial infarction (AMI), left ventricular function can potentially be a major determinant of hemodynamics with limited time for compensation, such as increased brain natriuretic peptide to attenuate congestion, and usually without any intervention to modify cardiac loading on arrival at the hospital during the acute phase. We, therefore, hypothesized that left ventricular function, expressed by the Tei index, allows noninvasive estimation of impaired hemodynamics for patients with AMI.

METHODS

We studied 86 consecutive patients with first AMI (34 inferoposterior and 52 anteroseptal). Tei index was obtained as: (a - b)/b, where a is the interval between the cessation and onset of mitral flow and b is the ejection time by aortic flow by pulsed Doppler echocardiography. By using pulmonary capillary wedge pressure (PCWP) > or = 18 mm Hg or <18 mm Hg and cardiac index (CI) < or = 2.2 L/min/m(2) or > 2.2 L/min/m(2) by consecutive catheterization, patients were classified into 4 subsets: subset I with normal hemodynamics; subset II with elevated PCWP; subset III with reduced CI; and subset IV with both elevated PCWP and reduced CI.

RESULTS

For patients with inferoposterior AMI, there was no significant correlation between the Tei index and PCWP or CI. For patients with anteroseptal AMI, however, the Tei index showed significant correlation both with PCWP (r = 0.59, P <.0001) and CI (r = -0.42, P <.01). Diagnosis of impaired hemodynamics (subset II-IV) by a Tei index > or = 0.60 showed a sensitivity, specificity, and accuracy of 86%, 82%, and 83%, respectively.

CONCLUSIONS

Although the Tei index has limitations to evaluate hemodynamics in patients with inferoposterior AMI, the index allows approximate but quick and practical noninvasive estimation of impaired hemodynamics in patients with anteroseptal AMI.

摘要

背景

Tei指数定义为等容收缩时间与等容舒张时间之和除以射血时间，已被提出用于表示整体左心室功能。对于急性心肌梗死（AMI）患者，左心室功能可能是血流动力学的主要决定因素，且代偿时间有限，如脑钠肽升高以减轻充血，并且在急性期入院时通常无需任何干预来改变心脏负荷。因此，我们假设，用Tei指数表示的左心室功能能够对AMI患者血流动力学受损情况进行无创评估。

方法

我们研究了86例连续的首次发生AMI的患者（34例下后壁心肌梗死和52例前间隔心肌梗死）。通过脉冲多普勒超声心动图测量二尖瓣血流终止与起始之间的间期（a）以及主动脉血流的射血时间（b），计算Tei指数：(a - b)/b。通过连续心导管检查，根据肺毛细血管楔压（PCWP）≥18 mmHg或<18 mmHg以及心脏指数（CI）≤2.2 L/min/m²或>2.2 L/min/m²，将患者分为4组：I组血流动力学正常；II组PCWP升高；III组CI降低；IV组PCWP升高且CI降低。

结果

对于下后壁AMI患者，Tei指数与PCWP或CI之间无显著相关性。然而，对于前间隔AMI患者，Tei指数与PCWP（r = 0.59，P <.0001）和CI（r = -0.42，P <.01）均显示出显著相关性。Tei指数≥0.60诊断血流动力学受损（II - IV组）的敏感性、特异性和准确性分别为86%、82%和83%。