右心室Tei指数在慢性血栓栓塞性肺动脉高压患者肺血栓内膜剥脱术前及术后无创评估中的应用价值。
Utility of right ventricular Tei index in the noninvasive evaluation of chronic thromboembolic pulmonary hypertension before and after pulmonary thromboendarterectomy.
作者信息
Blanchard Daniel G, Malouf Philip J, Gurudevan Swaminatha V, Auger William R, Madani Michael M, Thistlethwaite Patricia, Waltman Thomas J, Daniels Lori B, Raisinghani Ajit B, DeMaria Anthony N
机构信息
Division of Cardiology, University of California San Diego School of Medicine and UCSD Medical Center San Diego, La Jolla, CA 92037, USA.
出版信息
JACC Cardiovasc Imaging. 2009 Feb;2(2):143-9. doi: 10.1016/j.jcmg.2008.10.012.
OBJECTIVES
We evaluated the utility of tissue Doppler-derived right ventricular (RV) Tei (or myocardial performance) index in patients with chronic thromboembolic pulmonary hypertension (CTEPH) before and after pulmonary thromboendarterectomy (PTE) and assessed correlations with mean pulmonary artery pressure (mPAP), pulmonary vascular resistance (PVR), and cardiac output (CO).
BACKGROUND
The assessment of RV function is limited with 2-dimensional echocardiography. The RV Tei index, an indicator of RV myocardial performance, is derived by Doppler measurements and is unaffected by RV geometry. The use of tissue Doppler imaging (at the lateral tricuspid annulus) for RV Tei index calculation is simple and eliminates the need for pulsed-wave Doppler recordings of both RV inflow and outflow.
METHODS
Ninety-three patients with CTEPH were prospectively studied along with 13 control patients. Right ventricular tissue Doppler imaging and right heart catheterization were performed before and after PTE. Right ventricular Tei index was compared with values of mPAP, PVR, and CO with the use of linear regression.
RESULTS
Right ventricular Tei index was 0.52 +/- 0.19 in patients with CTEPH and 0.27 +/- 0.09 in control patients (p < 0.0001). After PTE, RV Tei index decreased to 0.33 +/- 0.10 (p < 0.0001). Pulmonary vascular resistance correlated well with RV Tei index before (r = 0.78, p < 0.0001) and after (r = 0.67, p < 0.0001) surgery. Also, the absolute change in Tei index in each patient after PTE correlated well with the concomitant change in PVR (r = 0.75, p < 0.0001). RV Tei index did not correlate as well with mPAP (pre-operatively: r = 0.55, p < 0.0001; post-operatively: r = 0.26, p = 0.03) or CO (pre-operatively: r = 0.57, p < 0.0001; post-operatively: r = 0.43, p < 0.0001).
CONCLUSIONS
These results demonstrate a correlation between RV Tei index and right heart hemodynamics (particularly PVR) in CTEPH. Because PVR is difficult to estimate noninvasively -- and yet correlates with disease severity -- the RV Tei index may be a valuable noninvasive parameter for monitoring disease severity in CTEPH and outcome after PTE.
目的
我们评估了组织多普勒衍生的右心室（RV）Tei指数（或心肌性能指数）在慢性血栓栓塞性肺动脉高压（CTEPH）患者肺动脉血栓内膜剥脱术（PTE）前后的效用，并评估其与平均肺动脉压（mPAP）、肺血管阻力（PVR）和心输出量（CO）的相关性。
背景
二维超声心动图对右心室功能的评估有限。RV Tei指数是右心室心肌性能的指标，通过多普勒测量得出，不受右心室几何形状的影响。使用组织多普勒成像（在三尖瓣环外侧）计算RV Tei指数简单，无需对右心室流入和流出进行脉冲波多普勒记录。
方法
对93例CTEPH患者和13例对照患者进行前瞻性研究。在PTE前后进行右心室组织多普勒成像和右心导管检查。使用线性回归将右心室Tei指数与mPAP、PVR和CO值进行比较。
结果
CTEPH患者的右心室Tei指数为0.52±0.19，对照患者为0.27±0.09（p<0.0001）。PTE后，RV Tei指数降至0.33±0.10（p<0.0001）。肺血管阻力在手术前（r=0.78，p<0.0001）和手术后（r=0.67，p<0.0001）与RV Tei指数相关性良好。此外，PTE后每位患者Tei指数的绝对变化与PVR的伴随变化相关性良好（r=0.
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