Bruch Christian, Stypmann Joerg, Grude Matthias, Gradaus Rainer, Breithardt Günter, Wichter Thomas
Department of Cardiology and Angiology, Hospital of the University of Münster, Münster, Germany.
Am Heart J. 2004 Oct;148(4):696-702. doi: 10.1016/j.ahj.2004.03.049.
Mitral annular velocities derived from tissue Doppler imaging (TDI) provide information about left ventricular (LV) long-axis function and allow for the assessment of LV filling pressures in selected subsets of patients. It was the aim of this study to assess the usefulness of TDI in patients with moderate to severe aortic valve stenosis (AS).
Twenty-three patients with moderate to severe AS (mean aortic valve area 0.8 +/- 0.4 cm2), in whom coronary artery disease had been ruled out, and 36 asymptomatic age-matched control subjects underwent assessment of ejection fraction, fractional shortening, and mitral inflow (E, A, E/A ratio). TDI velocities (S', E', A') were derived from the septal mitral annulus. In patients with AS, LV pressure before atrial contraction (LV pre-A pressure), LV end-diastolic pressure, and cardiac index were measured during cardiac catheterization.
In patients with AS, systolic (S') and early diastolic mitral annular velocities (E') were significantly reduced in comparison to control subjects (systolic, 5.5 +/- 1.2 vs 8.3 +/- 1.3 cm/s; early diastolic, 5.6 +/- 1.6 vs 10.2 +/- 3.0 cm/s, P <.001 for both comparisons), but ejection fraction, fractional shortening, and cardiac index were normal. In patients with AS, LV pre-A pressures (14 +/- 4 mm Hg) and end-diastolic pressures were high (19 +/- 7 mm Hg). In such patients, the mitral E/E' ratio was significantly related to LV pre-A pressure (r = 0.75, P <.001) and to LV end-diastolic pressure (r = 0.78, P <.001). In patients with AS, an E/E' ratio > or =13 identified an LV end-diastolic pressure >15 mm Hg, with a sensitivity of 93% and a specificity of 88%.
In patients with moderate to severe AS, TDI allows for a reliable, noninvasive estimation of filling pressures. In such patients, systolic long-axis function is impaired even in the presence of normal ejection fraction and cardiac index. Thus, TDI integrates information about systolic and diastolic performance and may be a useful addition in the echocardiographic workup and care of patients with AS.
组织多普勒成像（TDI）得出的二尖瓣环速度可提供有关左心室（LV）长轴功能的信息，并有助于评估特定患者亚组的左心室充盈压。本研究的目的是评估TDI在中重度主动脉瓣狭窄（AS）患者中的实用性。
23例中重度AS患者（平均主动脉瓣面积0.8±0.4 cm²），已排除冠状动脉疾病，以及36例年龄匹配的无症状对照受试者接受了射血分数、缩短分数和二尖瓣血流（E、A、E/A比值）的评估。TDI速度（S'、E'、A'）来自二尖瓣间隔环。在AS患者中，在心脏导管检查期间测量心房收缩前的左心室压力（LV pre-A压力）、左心室舒张末期压力和心脏指数。
与对照受试者相比，AS患者的收缩期（S'）和舒张早期二尖瓣环速度（E'）显著降低（收缩期，5.5±1.2对8.3±1.3 cm/s；舒张早期，5.6±1.6对10.2±3.0 cm/s，两组比较P均<.001），但射血分数、缩短分数和心脏指数正常。在AS患者中，LV pre-A压力（14±4 mmHg）和舒张末期压力较高（19±7 mmHg）。在这些患者中，二尖瓣E/E'比值与LV pre-A压力显著相关（r = 0.75，P<.001），与左心室舒张末期压力显著相关（r = 0.78，P<.001）。在AS患者中，E/E'比值≥13表明左心室舒张末期压力>15 mmHg，敏感性为93%，特异性为88%。
在中重度AS患者中，TDI可实现对充盈压的可靠、无创估计。在这些患者中，即使射血分数和心脏指数正常，收缩期长轴功能也会受损。因此，TDI整合了有关收缩期和舒张期功能的信息，可能是AS患者超声心动图检查和护理中的一项有用补充。
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