Acil Tayfun, Wichter Thomas, Stypmann Jörg, Janssen Frauke, Paul Matthias, Grude Matthias, Scheld Hans H, Breithardt Günter, Bruch Christian
Department of Cardiology and Angiology, University Hospital of Münster, Germany.
Int J Cardiol. 2005 Aug 18;103(2):175-81. doi: 10.1016/j.ijcard.2004.08.048. Epub 2005 Jan 8.
The prognostic value of tissue Doppler imaging (TDI) in patients with chronic congestive heart failure (CHF) has not been compared against conventional measures of systolic, diastolic and overall left ventricular LV performance. The aim of this study was to assess the prognostic value of TDI-derived parameters in patients with CHF.
One hundred thirty-two subjects with chronic CHF [due to ischemic (n=82) or dilated (n=50) cardiomyopathy, 101 males, mean age 57+/-11 years] underwent conventional two-dimensional/Doppler echocardiography and assessment of the Tei-index (isovolumic contraction time and isovolumic relaxation time divided by ejection time). Systolic, early and late diastolic mitral annular velocities (S', E' and A') were derived from pulsed TDI. A cardiac event (cardiac death, urgent cardiac transplantation or hospitalization due to decompensated CHF) was defined as the combined study endpoint.
The patients were followed for a mean of 224+/-123 days. Thirty-one patients suffered an event (cardiac death, n=5; urgent cardiac transplantation, n=2; hospitalization due to CHF, n=24). In patients with event, ejection fraction was lower (25+/-10 vs. 32+/-9%), mitral deceleration time was shorter (138+/-58 vs. 193+/-72 ms), and the peak mitral E/E'-ratio (16.1+/-6.6 vs. 10.6+/-5.0) was significantly elevated as compared to patients free of events (p<0.001 for all comparisons). In those patients, the Tei-index was elevated (1.09+/-0.39 vs. 0.86+/-0.26, p<0.01), and a restrictive mitral filling pattern was more frequent (51.6 vs. 17.5%, p<0.001). Stepwise multivariate analysis identified the mitral E/E'-ratio (p<0.001) and the Tei-index (p=0.019) as the only independent predictors of a combined event. E/E'-ratio was the best predictor of hospitalization due to CHF also. In patients with mitral E/E'-ratio>12.5 or Tei-index>0.90, outcome was poor.
In subjects with chronic CHF, the mitral E/E'-ratio is a stronger predictor of future cardiac events than conventional parameters of systolic, diastolic or overall LV performance. The E/E'-ratio may be a useful addition in the routine follow-up of such patients.
组织多普勒成像（TDI）在慢性充血性心力衰竭（CHF）患者中的预后价值尚未与收缩期、舒张期及左心室整体功能的传统测量指标进行比较。本研究旨在评估TDI衍生参数在CHF患者中的预后价值。
132例慢性CHF患者[因缺血性心肌病（n = 82）或扩张型心肌病（n = 50），男性101例，平均年龄57±11岁]接受了传统二维/多普勒超声心动图检查及Tei指数评估（等容收缩时间与等容舒张时间之和除以射血时间）。通过脉冲TDI得出收缩期、舒张早期及晚期二尖瓣环速度（S'、E'和A'）。将心脏事件（心源性死亡、紧急心脏移植或因失代偿性CHF住院）定义为联合研究终点。
患者平均随访224±123天。31例患者发生事件（心源性死亡，n = 5；紧急心脏移植，n = 2；因CHF住院，n = 24）。发生事件的患者与未发生事件的患者相比，射血分数更低（25±10%对32±9%），二尖瓣减速时间更短（138±58毫秒对193±72毫秒），二尖瓣E/E'峰值显著升高（16.1±6.6对10.6±5.0）（所有比较p<0.001）。在这些患者中，Tei指数升高（1.09±0.39对0.86±0.26，p<0.01），限制性二尖瓣充盈模式更常见（51.6%对17.5%，p<0.001）。逐步多因素分析确定二尖瓣E/E'比值（p<0.001）和Tei指数（p = 0.019）是联合事件的唯一独立预测因素。E/E'比值也是因CHF住院的最佳预测因素。二尖瓣E/E'比值>12.5或Tei指数>0.90的患者预后较差。
在慢性CHF患者中，二尖瓣E/E'比值比收缩期、舒张期或左心室整体功能的传统参数更能预测未来心脏事件。E/E'比值可能是此类患者常规随访中的一个有用补充。
