Hoffmann Soren, Mogelvang Rasmus, Olsen Niels Thue, Sogaard Peter, Fritz-Hansen Thomas, Bech Jan, Galatius Soren, Madsen Jan Kyst, Jensen Jan Skov
Department of Cardiology, Gentofte University Hospital, Post 4210, 65 Niels Andersens Vej, DK-2900 Hellerup, Copenhagen, Denmark.
Eur J Echocardiogr. 2010 Jul;11(6):544-9. doi: 10.1093/ejechocard/jeq015. Epub 2010 Mar 5.
Aim To determine how the left ventricular wall motion assessed by echocardiographic Tissue Doppler Imaging (TDI) is affected by increasing severity of coronary artery disease (CAD) among patients with stable angina pectoris and preserved ejection fraction.
This study comprises 82 patients with suspected angina pectoris, no previous cardiac history, and a normal ejection fraction, who were all examined with colour TDI prior to coronary angiography. Patients without significant stenoses (n = 35) constituted the control group and patients with significant stenoses (n = 47) were divided into three groups according to significant one-, two-, or three-vessel disease (n = 18, n = 14, and n = 15, respectively). Regional longitudinal peak systolic (s'), early (e'), and late diastolic (a') myocardial velocities were measured at six mitral annular sites and averaged to provide global estimates. Each patient with significant coronary disease was matched with a control of the same age, sex, body mass index, and status regarding diabetes and hypertension. Global systolic and diastolic performance by TDI (in terms of global s' and E/e') were negatively correlated to the number of vessels with significant stenoses (both P < 0.05). Regional analyses revealed that in one- and two-vessel disease, e' decreased significantly in the segments supplied by a stenotic artery. In patients with one-vessel disease, a' increased compensatorily with a significant reduction of e'/a'-ratio (0.86 +/- 0.24 vs. 1.00 +/- 0.28, P < 0.05). Both regional and global s' was significantly reduced in patients with three-vessels disease.
Colour TDI performed at rest in patients with stable angina and preserved ejection fraction reveals both diastolic and systolic dysfunction and the nature of the dysfunction depends on the extent of the CAD.
目的 确定在稳定型心绞痛且射血分数保留的患者中，超声心动图组织多普勒成像（TDI）评估的左心室壁运动如何受冠状动脉疾病（CAD）严重程度增加的影响。
本研究包括82例疑似心绞痛、无既往心脏病史且射血分数正常的患者，他们均在冠状动脉造影前接受了彩色TDI检查。无明显狭窄的患者（n = 35）构成对照组，有明显狭窄的患者（n = 47）根据单支、双支或三支血管病变分为三组（分别为n = 18、n = 14和n = 15）。在六个二尖瓣环部位测量区域纵向收缩期峰值（s'）、舒张早期（e'）和舒张晚期（a'）心肌速度，并取平均值以提供整体评估。每例有明显冠状动脉疾病的患者与年龄、性别、体重指数以及糖尿病和高血压状况相同的对照者匹配。TDI的整体收缩和舒张功能（以整体s'和E/e'表示）与有明显狭窄的血管数量呈负相关（均P < 0.05）。区域分析显示，在单支和双支血管病变中，狭窄动脉供血节段的e'显著降低。在单支血管病变患者中，表示舒张功能的a'代偿性增加，e'/a'比值显著降低（0.86±0.24对1.00±0.28，P < 0.05）。三支血管病变患者的区域和整体s'均显著降低。
对稳定型心绞痛且射血分数保留的患者进行静息状态下的彩色TDI检查，可发现舒张和收缩功能障碍，且功能障碍的性质取决于CAD的程度。
