Hamdan Ashraf, Shapira Yaron, Bengal Tuvia, Mansur Mali, Vaturi Mordehay, Sulkes Jaqueline, Battler Alexander, Sagie Alex
Echocardiography Unit, Department of Cardiology, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel.
J Heart Lung Transplant. 2006 Feb;25(2):214-8. doi: 10.1016/j.healun.2005.09.002.
Tissue Doppler imaging (TDI) provides rapid assessment of systolic and diastolic myocardial function. However, the added value of TDI to standard Doppler echocardiographic measurements in predicting symptoms and outcome of advanced heart failure remains unknown.
The study cohort comprised 45 patients with congestive heart failure, defined as New York Heart Association functional class III and IV, who were referred to our department for evaluation for heart transplantation. Twenty healthy subjects were the controls. Conventional echo Doppler was used to assess left ventricular (LV) ejection fraction, peak velocities of transmitral early and late diastolic LV filling, the ratio of transmitral early to late LV filling velocity, and E-deceleration time. TDI measurements recorded at the mitral annulus included systolic velocity, early and late diastolic velocities, and the ratio of early to late diastolic velocity. The ratio of transmitral early LV filling velocity to early diastolic TDI velocity of the mitral annulus (E/E') was calculated. All patients were followed for cardiac-related death and hospitalization for heart failure.
Patients with functional class IV had a significantly higher E/E' ratio than did patients with functional class III (12.9 +/- 2.8 vs 8.3 +/- 1.7, p < 0.001) and the controls (5.4 +/- 1.3, p < 0.001). Except for transmitral late filling velocity, all conventional echo Doppler parameters and TDI variables significantly correlated with functional class. On multivariate stepwise analysis, however, the E/E' ratio was the only independent predictor of functional class (p = 0.003). E/E' also correlated with cardiac mortality and hospitalization.
Conventional Doppler indices and TDI parameters correlated with functional class in patients with advanced heart failure. The E/E' ratio, which probably reflects high LV end-diastolic pressure, was the best measure for differentiating patients with functional class III and IV, and it also correlated with cardiac mortality and hospitalization for worsening heart failure, thereby providing additional value to standard echocardiographic measures.
组织多普勒成像（TDI）可快速评估心肌的收缩和舒张功能。然而，在预测晚期心力衰竭的症状和预后方面，TDI相较于标准多普勒超声心动图测量的附加价值仍不明确。
研究队列包括45例充血性心力衰竭患者，定义为纽约心脏协会心功能Ⅲ级和Ⅳ级，他们被转诊至我科进行心脏移植评估。20名健康受试者作为对照。采用传统超声多普勒评估左心室（LV）射血分数、二尖瓣舒张早期和晚期左心室充盈峰值速度、二尖瓣早期与晚期左心室充盈速度比值以及E峰减速时间。在二尖瓣环处记录的TDI测量值包括收缩期速度、舒张早期和晚期速度以及舒张早期与晚期速度比值。计算二尖瓣早期左心室充盈速度与二尖瓣环舒张早期TDI速度的比值（E/E'）。所有患者均随访心脏相关死亡和因心力衰竭住院情况。
心功能Ⅳ级患者的E/E'比值显著高于心功能Ⅲ级患者（12.9±2.8对8.3±1.7，p<0.001）和对照组（5.4±1.3，p<0.001）。除二尖瓣晚期充盈速度外，所有传统超声多普勒参数和TDI变量均与心功能分级显著相关。然而，多因素逐步分析显示，E/E'比值是心功能分级的唯一独立预测因素（p = 0.003）。E/E'还与心脏死亡率和住院率相关。
传统多普勒指标和TDI参数与晚期心力衰竭患者的心功能分级相关。E/E'比值可能反映左心室舒张末期压力升高，是区分心功能Ⅲ级和Ⅳ级患者的最佳指标，并且与心脏死亡率和因心力衰竭恶化住院率相关，从而为标准超声心动图测量提供了附加价值。
