Lee Kaeng W, Blann Andrew D, Lip Gregory Y H
University Department of Medicine, City Hospital, Birmingham, UK.
Am Heart J. 2005 Oct;150(4):756-66. doi: 10.1016/j.ahj.2004.11.019.
Pulsed tissue Doppler imaging (TDI) allows direct measurement of systolic and diastolic function of the left ventricle. In patients with coronary artery disease (CAD), myocardial ischemia-related impaired diastolic function may be linked to systemic endothelial damage/dysfunction and increased thrombogenesis. We hypothesized relationships between TDI-defined diastolic dysfunction and plasma von Willebrand factor (vWf, marking endothelial damage/dysfunction), soluble P-selectin (sP-sel, reflecting platelet activation), fibrin D dimer (an index of fibrin turnover and thrombogenesis), fibrinogen, and plasma viscosity (PV) in CAD.
Conventional 2-dimensional Doppler echocardiography and TDI were performed in 75 stable CAD patients (55 men, 59 +/- 11 years) and 40 age- and sex-matched healthy controls. Peak systolic (Sm), peak early (Em), and late (Am) diastolic mitral annular velocities measured at 4 sites (septal, lateral, inferior, and anterior) were averaged as global systolic and diastolic left ventricular function, respectively. The mean TDI velocities were dichotomized into low and high (below/above median) groups. Plasma vWf, sP-sel, D dimer (enzyme-linked immunosorbent assay), fibrinogen (modified Clauss), and PV levels were measured.
CAD patients had significantly lower Sm, Em, Em/Am ratio, and a higher ratio of early transmitral flow E-velocity over Em (E/Em) when compared with controls (all P < .05). On multivariate analysis, adjusted for age, ejection fraction, and clinical variables, the differences in the group means of vWf, sP-sel, and fibrinogen remained significantly different between the low and high TDI indexes. D-dimer levels were unrelated to any TDI indexes. None of the transmitral flow indexes were independently related to the research indexes.
In patients with CAD, diastolic dysfunction was closely associated with increased platelet activation and endothelial damage/dysfunction independent of systolic function. TDI-derived indexes are more sensitively related to plasma hemostatic markers than transmitral indexes in middle-aged patients with CAD.
脉冲组织多普勒成像（TDI）可直接测量左心室的收缩和舒张功能。在冠心病（CAD）患者中，心肌缺血相关的舒张功能受损可能与全身内皮损伤/功能障碍及血栓形成增加有关。我们推测CAD患者中TDI定义的舒张功能障碍与血浆血管性血友病因子（vWf，标志内皮损伤/功能障碍）、可溶性P选择素（sP-sel，反映血小板活化）、纤维蛋白D二聚体（纤维蛋白周转和血栓形成指标）、纤维蛋白原及血浆黏度（PV）之间存在关联。
对75例稳定型CAD患者（55例男性，年龄59±11岁）及40例年龄和性别匹配的健康对照者进行常规二维多普勒超声心动图和TDI检查。在4个部位（间隔、侧壁、下壁和前壁）测量的二尖瓣环收缩期峰值（Sm）、舒张早期峰值（Em）和晚期峰值（Am）速度分别作为左心室整体收缩和舒张功能的平均值。将平均TDI速度分为低和高（低于/高于中位数）两组。测量血浆vWf、sP-sel、D二聚体（酶联免疫吸附测定）、纤维蛋白原（改良Clauss法）及PV水平。
与对照组相比，CAD患者的Sm、Em、Em/Am比值显著降低，且舒张早期二尖瓣血流E速度与Em的比值（E/Em）更高（均P<.05）。多因素分析中，校正年龄、射血分数及临床变量后，低和高TDI指数组间vWf、sP-sel和纤维蛋白原的组均值差异仍有统计学意义。D-二聚体水平与任何TDI指数均无关。二尖瓣血流指数均与研究指标无独立相关性。
在CAD患者中，舒张功能障碍与血小板活化增加及内皮损伤/功能障碍密切相关，且独立于收缩功能。在中年CAD患者中，TDI衍生指标比二尖瓣血流指标与血浆止血标志物的相关性更敏感。
