心肌做功指数在单纯舒张功能不全患者中的临床价值
Clinical value of myocardial performance index in patients with isolated diastolic dysfunction.
作者信息
Fernandes José Maria Gonçalves, de Oliveira Romão Benício, Rivera Ivan Romero, Mendonça Maria Alayde, Costa Francisco de Assis, Lira Handro Margareth de Souza, Campos Orlando, De Paola Ângelo Amato V, Moisés Valdir Ambrósio
机构信息
Faculty of Medicine, Federal University of Alagoas, Av Lourival Melo Mota, sn, Tabuleiro dos Martins, Maceió, 57072-900, Brazil.
Federal University of Alagoas, Arapiraca, Brazil.
出版信息
Cardiovasc Ultrasound. 2019 Aug 13;17(1):17. doi: 10.1186/s12947-019-0167-x.
AIMS
The Doppler-derived myocardial performance index (MPI) has been considered as a diagnostic and prognostic Doppler marker for many different clinical conditions. The purpose of this study was to determine the diagnostic accuracy of traditional Pulsed-wave Doppler (PWD-MPI) and Pulsed-wave tissue Doppler imaging (TDI-MPI) and the degree of agreement between these methods in patients with grade-I diastolic dysfunction (DDI) and a normal ejection fraction.
METHODS
Forty-seven consecutive ambulatory patients with DDI were compared to 51 healthy subjects with normal echocardiograms. All subjects underwent measurement of time intervals and MPI with PWD and pulsed TDI.
RESULTS
TDI-MPI and PWD-MPI were significantly higher in patients with DDI than in control subjects: 0.49 ± 0.14 vs. 0.40 ± 0.09 (P < 0.001) and 0.45 ± 0.11 vs. 0.37 ± 0.08 (P < 0.001), respectively. Cutoff values of TDI-MPI > 0.42 and PWD-MPI > 0.40 identified DDI subjects, with sensitivities of 74 and 64%; specificities of 61 and 69%; positive likelihood ratios of 1.9 and 2.0; and negative likelihood ratios of 0.42 and 0.53, respectively; no significant difference was noted between the areas under the ROC curves of TDI-MPI and PWD-MPI (P = 0.77). Bland-Altman plots showed wide limits of agreement between these indices: - 0.17 to 0.23 in healthy subjects and - 0.24 to 0.32 in DDI patients.
CONCLUSION
PWD-MPI and TDI-MPI showed poor clinical agreement and were not reliable parameters for the assessment of left ventricular diastolic function.
目的
在许多不同临床情况下，多普勒衍生的心肌性能指数（MPI）被视为一种诊断和预后的多普勒标志物。本研究的目的是确定传统脉冲波多普勒（PWD-MPI）和脉冲波组织多普勒成像（TDI-MPI）在I级舒张功能障碍（DDI）且射血分数正常的患者中的诊断准确性，以及这些方法之间的一致性程度。
方法
将47例连续的门诊DDI患者与51例超声心动图正常的健康受试者进行比较。所有受试者均接受了PWD和脉冲TDI的时间间隔和MPI测量。
结果
DDI患者的TDI-MPI和PWD-MPI显著高于对照组：分别为0.49±0.14 vs. 0.40±0.09（P<0.001）和0.45±0.11 vs. 0.37±0.08（P<0.001）。TDI-MPI>0.42和PWD-MPI>0.40的临界值可识别DDI受试者，敏感性分别为74%和64%；特异性分别为61%和69%；阳性似然比分别为1.9和2.0；阴性似然比分别为0.42和0.53；TDI-MPI和PWD-MPI的ROC曲线下面积之间无显著差异（P=0.77）。Bland-Altman图显示这些指标之间的一致性界限较宽：健康受试者为-0.17至0.23，DDI患者为-0.24至0.32。
结论
PWD-MPI和TDI-MPI临床一致性较差，不是评估左心室舒张功能的可靠参数。
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