组织多普勒超声心动图——工具正确，使用有误的一个案例。
Tissue Doppler echocardiography - a case of right tool, wrong use.
作者信息
Thomas George
机构信息
Department of Cardiology, Indira Gandhi Co-operative Hospital and the Co-operative Medical College, Kochi 682 020, India.
出版信息
Cardiovasc Ultrasound. 2004 Aug 12;2:12. doi: 10.1186/1476-7120-2-12.
BACKGROUND
The developments in echocardiography or ultrasound cardiography (UCG) have improved our clinical capabilities. However, advanced hardware and software capabilities have resulted in UCG facilities of dubious clinical benefits. Is tissue Doppler echocardiography (TDE) is one such example?
PRESENTATION OF THE HYPOTHESIS
TDE has been touted as advancement in the field of echocardiography. The striking play of colors, impressive waveforms and the seemingly accurate velocity values could be deceptive. TDE is a clear case of inappropriate use of technology.
TESTING THE HYPOTHESIS
To understand this, a comparison between flow Doppler and tissue Doppler is made. To make clinically meaningful velocity measurements with Doppler, we need prior knowledge of the line of motion. This is possible in blood flow but impossible in the complex myocardial motion. The qualitative comparison makes it evident that Doppler is best suited for flow studies.
IMPLICATIONS OF THE HYPOTHESIS
As of now TDE is going backwards using an indirect method when direct methods are better. The work on TDE at present is only debatable 'research and publication' material and do not translate into tangible clinical benefits. There are several advances like curved M-mode, strain rate imaging and tissue tracking in TDE. However these have been disappointing. This is due to the basic flaw in the application of the principles of Doppler. Doppler is best suited for flow studies and applying it to tissue motion is illogical. All data obtained by TDE is scientifically incorrect. This makes all the published papers on the subject flawed. Making diagnostic decisions based on this faulty application of technology would be unacceptable to the scientific cardiologist.
背景
超声心动图或心脏超声检查（UCG）的发展提升了我们的临床能力。然而，先进的硬件和软件功能导致一些UCG设备的临床效益存疑。组织多普勒超声心动图（TDE）就是这样一个例子吗？
假说的提出
TDE被誉为超声心动图领域的一项进展。其鲜明的色彩显示、令人印象深刻的波形以及看似精确的速度值可能具有欺骗性。TDE是技术使用不当的一个明显例子。
对假说的验证
为了理解这一点，对血流多普勒和组织多普勒进行了比较。要使用多普勒进行具有临床意义的速度测量，我们需要事先了解运动方向。这在血流中是可行的，但在复杂的心肌运动中则不可能。定性比较表明，多普勒最适合血流研究。
假说的影响
目前，当有更好的直接方法时，TDE却在使用间接方法，这是一种倒退。目前关于TDE的工作只是有争议的“研究和发表”材料，并没有转化为切实的临床效益。TDE中有一些进展，如曲线M型、应变率成像和组织追踪。然而，这些进展令人失望。这是由于多普勒原理应用中的基本缺陷。多普勒最适合血流研究，将其应用于组织运动是不合逻辑的。通过TDE获得的所有数据在科学上都是不正确的。这使得所有关于该主题的已发表论文都存在缺陷。基于这种错误的技术应用做出诊断决策，对于科学的心脏病专家来说是不可接受的。
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