Hameed Adnan K, Gosal Tirath, Fang Tielan, Ahmadie Roien, Lytwyn Matthew, Barac Ivan, Zieroth Shelley, Hussain Farrukh, Jassal Davinder S
Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
Cardiovasc Ultrasound. 2008 Mar 20;6:11. doi: 10.1186/1476-7120-6-11.
Echocardiography is widely used in the management of patients with cardiogenic shock (CS). Left ventricular ejection fraction (EF) has been shown to be an independent predictor of survival in CS. Tissue Doppler Imaging (TDI) is a sensitive echocardiographic technique that allows for the early quantitative assessment of regional left ventricular dysfunction. TDI derived indices, including systolic velocity (S'), early (E') and late (A') diastolic velocities of the lateral mitral annulus, are reduced in heart failure patients (EF < 30%) and portend a poor prognosis. In CS patients, the application of TDI prior to revascularization remains unknown.
To characterize TDI derived indices in CS patients as compared to patients with chronic CHF.
Between 2006 and 2007, 100 patients were retrospectively evaluated who underwent echocardiography for assessment of LV systolic function. This population included: Group I) 50 patients (30 males, 57 +/- 13 years) with chronic CHF as controls; and Group II) 50 patients (29 males, 58 +/- 10 years) with CS. Spectral Doppler indices including peak early (E) and late (A) transmitral velocities, E/A ratio, and E-wave deceleration time were determined. Tissue Doppler indices including S', E' and A' velocities of the lateral annulus were measured.
Of the entire cohort, the mean LVEF was 25 +/- 5%. Cardiogenic shock patients demonstrated significantly lower lateral S', E' and a higher E/E' ratio (p < 0.01), as compared to CHF patients. The in-hospital mortality in the CHF cohort was 5% as compared to the CS group with an in hospital mortality of 40%. In the subset of CS patients (n = 30) who survived, the mean S' at presentation was higher as compared to those patients who died in hospital (3.5 +/- 0.5 vs. 1.8 +/- 0.5 cm/s).
Despite similar reduction in LV systolic function, CS patients have reduced myocardial velocities and higher filling pressures using TDI, as compared to CHF patients. Whether TDI could be a reliable tool to determine CS patients with the best chance of recovery following revascularization is yet to be determined.
超声心动图广泛应用于心源性休克（CS）患者的管理。左心室射血分数（EF）已被证明是CS患者生存的独立预测指标。组织多普勒成像（TDI）是一种敏感的超声心动图技术，可对左心室局部功能障碍进行早期定量评估。心力衰竭患者（EF<30%）的TDI衍生指标，包括二尖瓣环侧壁的收缩期速度（S'）、舒张早期（E'）和晚期（A'）速度降低，预示预后不良。在CS患者中，血管重建术前TDI的应用情况尚不清楚。
将CS患者的TDI衍生指标与慢性心力衰竭患者进行比较。
2006年至2007年，对100例行超声心动图评估左心室收缩功能的患者进行回顾性评估。该人群包括：I组）50例慢性心力衰竭患者（30例男性，年龄57±13岁）作为对照组；II组）50例CS患者（29例男性，年龄58±10岁）。测定频谱多普勒指标，包括二尖瓣血流峰值早期（E）和晚期（A）速度、E/A比值和E波减速时间。测量组织多普勒指标，包括二尖瓣环侧壁的S'、E'和A'速度。
在整个队列中，平均左心室射血分数为25±5%。与心力衰竭患者相比，心源性休克患者的二尖瓣环侧壁S'、E'显著降低，E/E'比值更高（p<0.01）。心力衰竭队列的院内死亡率为5%，而CS组的院内死亡率为40%。在存活的CS患者亚组（n=30）中，入院时的平均S'高于院内死亡患者（3.5±0.
