Gromadziński Leszek, Targoński Ryszard, Pruszczyk Piotr
Department of Internal Medicine, Gastroenterology and Hepatology, University Clinical Hospital, University of Warmia and Mazury, Olsztyn, Poland.
Department of Internal Medicine and Cardiology, Municipal Hospital, Olsztyn, Poland.
Adv Clin Exp Med. 2014 May-Jun;23(3):371-6. doi: 10.17219/acem/37127.
Acute pulmonary embolism (APE), despite improvements in diagnostic methods, often remains undiagnosed. Recently, systolic dysfunction has also been described as assessed by new echocardiographic techniques, such as tissue Doppler imaging (TDI).
In our study we have attempted to assess diastolic function within the mitral and tricuspid annuli in congestive heart failure (CHF) patients with coexisting APE.
The study included 39 patients with CHF with sinus rhythm, 20 patients with confirmed APE (PE+), and 19 patients with excluded APE (PE-). APE was confirmed or excluded on the result of spiral chest computed tomography. Tissue Doppler imaging (TDI) was performed to measure early diastolic velocity (Em), late diastolic velocity (Am) of both examined annuli, and Em/AmLV and Em/AmRV ratios.
PE+ subjects were found to have lower EmRV than PE- subjects [4.2 (2.0-14) vs. 6.5 (0.8-14) cm/s; p = 0.006]. The AmLV was higher in the PE+ vs. PE- group [8.4 (3.0-15.2) vs. 3.0 (1.0-14.8), p = 0.0038]. Em/AmLV and Em/AmRV were significantly lower in the PE + vs. PE- group [0.55 (0.2-1.4) vs. 1.6 (0.16-5.4), p = 0.0089 and 0.41 (0.17-2.5) vs. 1.5 (0.05-5.5), p = 0.0069]. For the APE diagnosis, the area under the ROC curve calculated for AmLV and Em/AmLV was 0.771 (95% CI 0.509-0.890) and 0.742 (95% CI 0.577-0.868) respectively. For the APE diagnosis, the sensitivity, specificity, positive and negative predictive values for AmLV = 4.9 cm/s were: 95%, 68.4%, 76% and 92.9%, respectively and for Em/AmLV = 1.0 were: 95%, 63.2%, 73.1% and 92.3%, respectively.
TDI reveals changes in mitral and tricuspid annular velocities in CHF patients with confirmed APE. These patients exhibit a reduced EmRV and increased AmLV.
尽管诊断方法有所改进，但急性肺栓塞（APE）常常仍未被诊断出来。最近，收缩功能障碍也已通过新的超声心动图技术（如组织多普勒成像（TDI））得以描述。
在我们的研究中，我们试图评估合并APE的充血性心力衰竭（CHF）患者二尖瓣和三尖瓣环的舒张功能。
该研究纳入了39例窦性心律的CHF患者，20例确诊为APE的患者（PE+），以及19例排除APE的患者（PE-）。根据胸部螺旋计算机断层扫描结果确诊或排除APE。采用组织多普勒成像（TDI）测量两个被检查瓣环的舒张早期速度（Em）、舒张晚期速度（Am）以及Em/AmLV和Em/AmRV比值。
发现PE+组患者的EmRV低于PE-组患者[4.2（2.0 - 14）对6.5（0.8 - 14）cm/s；p = 0.006]。PE+组的AmLV高于PE-组[8.4（3.0 - 15.2）对3.0（1.0 - 14.8），p = 0.0038]。PE+组的Em/AmLV和Em/AmRV显著低于PE-组[0.55（0.2 - 1.4）对1.6（0.16 - 5.4），p = 0.0089；以及0.41（0.17 - 2.5）对1.5（0.05 - 5.5），p = 0.0069]。对于APE诊断，根据AmLV和Em/AmLV计算的ROC曲线下面积分别为0.771（95%CI 0.509 - 0.890）和0.742（95%CI 0.577 - 0.868）。对于APE诊断，当AmLV = 4.9 cm/s时，敏感性、特异性、阳性和阴性预测值分别为：95%、68.4%、76%和92.9%；当Em/AmLV = 1.0时，敏感性、特异性、阳性和阴性预测值分别为：95%、63.2%、73.1%和92.3%。
TDI显示确诊为APE的CHF患者二尖瓣和三尖瓣环速度有变化。这些患者EmRV降低，AmLV升高。
