心肌梗死后患者超声心动图参数与运动试验持续时间的关系。

Relationship between echocardiographic parameters and exercise test duration in patients after myocardial infarction.

机构信息

Department of Cardiology, Medical University of Łódź, Poland.

出版信息

Cardiol J. 2009;16(6):507-13.

PMID:19950086

Abstract

BACKGROUND

The interdependence between echocardiographic parameters of left ventricle function, severity of heart failure (HF) and exercise test duration has not been thoroughly examined.

METHODS

We compared echocardiographic data in patients after myocardial infarction divided according to NYHA class to mild (class I and II, group 1 = 24 subjects) and advanced HF group (III and IV, group 2 = 36) and assessed their correlation with exercise duration (ED) in a symptom-limited treadmill test. Then we tried to determine independent predictors of ED.

RESULTS

The group with advanced HF had lower left ventricle ejection fraction, shorter duration and deceleration times of both mitral inflow waves (Et and At, Edt and Adt) and higher E/A ratio (1.4 +/- 1.1 vs. 0.9 +/- 0.4; p < 0.05) with more frequent restriction and pseudonormalization pattern (56% vs. 12%). Also early wave propagation (21 +/- 7 vs. 29 +/- 11 cm/s; p < 0.001) and all tissue Doppler velocities were lower, but ratio of early wave peak velocity to early diastolic velocity of mitral annulus was higher (E/E' 10.5 +/- 5 vs. 6.1 +/- 1.3 for velocity ratio; p < 0.001) in subjects with more severe clinical symptoms. Significant negative correlation with ED was observed for difference between duration of pulmonary vein atrial reversal flow and atrial wave of mitral inflow (DeltaAt; r = -0.54) and for E/E' ratio (r = -0.48), the highest positive correlation for left ventricular ejection fraction and duration of mitral inflow atrial phase (EF; r = 0.48, At; r = 0.46). In multivariate stepwise regression analysis two independent predictors of ED were identified: age and DeltaAt (Art-At).

CONCLUSIONS

Diastolic parameters showing the strongest correlation with ED (DeltaAt and E/E') are connected with restrictive left ventricle physiology. The only independent predictors of exercise duration in patients after myocardial infarction were: age and DeltaAt.

摘要

背景

左心室功能的超声心动图参数、心力衰竭（HF）严重程度和运动试验持续时间之间的相互依赖关系尚未得到彻底研究。

方法

我们比较了根据纽约心脏协会（NYHA）分级分为轻度（I 级和 II 级，第 1 组=24 例）和晚期 HF 组（III 级和 IV 级，第 2 组=36 例）的心肌梗死后患者的超声心动图数据，并评估了它们与症状限制跑步机测试中运动持续时间（ED）的相关性。然后，我们试图确定 ED 的独立预测因子。

结果

晚期 HF 组的左心室射血分数较低，二尖瓣流入波（Et 和 At、Edt 和 Adt）的持续时间和减速时间较短，E/A 比值较高（1.4±1.1 比 0.9±0.4；p<0.05），限制和假性正常化模式更常见（56%比 12%）。早期波传播速度（21±7 比 29±11 cm/s；p<0.001）和所有组织多普勒速度均较低，但二尖瓣环早期波峰速度与早期舒张速度的比值较高（E/E'10.5±5 比 6.1±1.3 比速度比；p<0.001）在症状更严重的患者中。ED 与肺静脉心房反向血流和二尖瓣流入心房波之间的持续时间差异（DeltaAt；r=-0.54）和 E/E'比值（r=-0.48）呈显著负相关，左心室射血分数和二尖瓣流入心房期持续时间（EF；r=0.48，At；r=0.46）呈最高正相关。多元逐步回归分析确定了 ED 的两个独立预测因子：年龄和 DeltaAt（Art-At）。