Kasner Mario, Westermann Dirk, Steendijk Paul, Gaub Regina, Wilkenshoff Ursula, Weitmann Kerstin, Hoffmann Wolfgang, Poller Wolfgang, Schultheiss Heinz-Peter, Pauschinger Matthias, Tschöpe Carsten
Department of Cardiology and Pneumology, Charité-University Medicine Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany.
Circulation. 2007 Aug 7;116(6):637-47. doi: 10.1161/CIRCULATIONAHA.106.661983. Epub 2007 Jul 23.
Various conventional and tissue Doppler echocardiographic indexes were compared with pressure-volume loop analysis to assess their accuracy in detecting left ventricular (LV) diastolic dysfunction in patients with heart failure with normal ejection fraction (HFNEF).
Diastolic dysfunction was confirmed by pressure-volume loop analysis obtained by conductance catheter in 43 patients (19 men) with HFNEF. Their Doppler indexes were compared with those of 12 control patients without heart failure symptoms and with normal ejection fraction. Invasively measured indexes for diastolic relaxation (tau, dP/dt(min)), LV end-diastolic pressure, and LV end-diastolic pressure-volume relationship (stiffness, b [dP/dV], and stiffness constant, beta) were correlated with several conventional mitral flow and tissue Doppler imaging indexes. Conventional Doppler indexes correlated moderately with the degree of LV relaxation index, tau (E/A: r=-0.36, P=0.013; isovolumic relaxation time: r=0.31, P=0.040) and b (deceleration time: r=0.39, P=0.012) but not with beta, in contrast to the tissue Doppler imaging indexes E'/A'(lateral) (r=-0.37, P=0.008) and E/E'(lateral) (r=0.53, P<0.001). Diastolic dysfunction was detected in 70% of the HFNEF patients by mitral flow Doppler but in 81% and 86% by E'/A'(lateral), and E/E'(lateral), respectively.
Of all echocardiographic parameters investigated, the LV filling index E/E'(lateral) was identified as the best index to detect diastolic dysfunction in HFNEF in which the diagnosis of diastolic dysfunction was confirmed by conductance catheter analysis. We recommend its use as an essential tool for noninvasive diagnostics of diastolic function in patients with HFNEF.
将各种传统及组织多普勒超声心动图指标与压力-容积环分析进行比较，以评估其在检测射血分数正常的心力衰竭（HFNEF）患者左心室（LV）舒张功能障碍方面的准确性。
通过电导导管获得压力-容积环分析，证实43例（19例男性）HFNEF患者存在舒张功能障碍。将他们的多普勒指标与12例无心力衰竭症状且射血分数正常的对照患者的指标进行比较。舒张期松弛的有创测量指标（τ，dP/dt（min））、左心室舒张末压以及左心室舒张末压力-容积关系（硬度，b [dP/dV]，以及硬度常数，β）与多个传统二尖瓣血流和组织多普勒成像指标相关。传统多普勒指标与左心室松弛指数τ的程度中度相关（E/A：r = -0.36，P = 0.013；等容舒张时间：r = 0.31，P = 0.040）以及与b相关（减速时间：r = 0.39，P = 0.012），但与β不相关，这与组织多普勒成像指标E'/A'（侧壁）（r = -0.37，P = 0.008）和E/E'（侧壁）（r = 0.53，P < 0.001）相反。二尖瓣血流多普勒检测到70%的HFNEF患者存在舒张功能障碍，但E'/A'（侧壁）和E/E'（侧壁）分别检测到81%和86%的患者存在舒张功能障碍。
在所有研究的超声心动图参数中，左心室充盈指数E/E'（侧壁）被确定为检测HFNEF舒张功能障碍的最佳指标，其中舒张功能障碍的诊断通过电导导管分析得以证实。我们建议将其用作HFNEF患者舒张功能无创诊断的重要工具。
