Yamada H, Oki T, Tabata T, Iuchi A, Ito S
Second Department of Internal Medicine, School of Medicine, The University of Tokushima, Japan.
J Am Soc Echocardiogr. 1998 May;11(5):442-9. doi: 10.1016/s0894-7317(98)70024-0.
To assess the usefulness of the tissue Doppler imaging variables for the evaluation of left ventricular (LV) systolic function, we compared variables obtained by the pulsed Doppler method with the LV ejection fraction (%EF) and the maximum value for the first derivative of LV pressure (peak dP/dt). We examined 65 patients, including 15 patients with noncardiac chest pain, 15 with ischemic heart disease, 15 with dilated cardiomyopathy, 10 with hypertensive heart disease, and 10 with asymmetric septal hypertrophic cardiomyopathy. The subendocardial systolic wall motion velocity patterns were recorded for LV posterior wall and ventricular septum in the parasternal LV long-axis view. The peak dP/dt was significantly lower in the hypertensive heart disease, hypertrophic cardiomyopathy, and dilated cardiomyopathy groups. The peak systolic velocity was lower and the time from the electrocardiographic Q wave to the peak of the systolic wave for the posterior wall was longer in the hypertensive heart disease (5.9 +/- 0.5 cm/sec and 215 +/- 21 msec, respectively), hypertrophic cardiomyopathy (6.2 +/- 0.9 cm/sec and 217 +/- 17 msec, respectively), and dilated cardiomyopathy (5.2 +/- 0.8 cm/sec and 235 +/- 26 msec, respectively) groups than in the noncardiac chest pain (7.7 +/- 0.9 cm/sec and 187 +/- 24 msec, respectively) and the ischemic heart disease (7.6 +/- 0.8 cm/sec and 184 +/- 22 msec, respectively) groups. In all groups, the peak systolic velocity and the time from the electrocardiographic Q wave to the peak of the systolic wave for the posterior wall correlated directly and inversely, respectively, with the %EF (r = 0.59, p < 0.0001; r = -0.59, p < 0.0001) and the peak dP/dt (r = 0.75, p < 0.0001; r = -0.68, p < 0.0001). Both tissue Doppler variables for the ventricular septum did not correlate with the %EF but roughly correlated with peak dP/dt. We conclude that the systolic LV wall motion velocity parameters obtained by pulsed tissue Doppler imaging may be useful for noninvasive evaluation of global LV systolic function in patients with no regional asynergy.
为评估组织多普勒成像变量对评价左心室（LV）收缩功能的有用性，我们将脉冲多普勒法获得的变量与左心室射血分数（%EF）及左心室压力一阶导数最大值（峰值dP/dt）进行了比较。我们检查了65例患者，包括15例非心源性胸痛患者、15例缺血性心脏病患者、15例扩张型心肌病患者、10例高血压性心脏病患者和10例肥厚型梗阻性心肌病患者。在胸骨旁左心室长轴视图中记录左心室后壁和室间隔的心内膜下收缩期壁运动速度模式。高血压性心脏病、肥厚型心肌病和扩张型心肌病组的峰值dP/dt显著降低。高血压性心脏病组（分别为5.9±0.5cm/秒和215±21毫秒）、肥厚型心肌病组（分别为6.2±0.9cm/秒和217±17毫秒）和扩张型心肌病组（分别为5.2±0.8cm/秒和235±26毫秒）的后壁收缩期峰值速度较低，且从心电图Q波至收缩期波峰的时间较长，与非心源性胸痛组（分别为7.7±0.9cm/秒和187±24毫秒）和缺血性心脏病组（分别为7.6±0.8cm/秒和184±22毫秒）相比。在所有组中，后壁收缩期峰值速度以及从心电图Q波至收缩期波峰的时间分别与%EF呈直接和反向相关（r = 0.59，p < 0.0001；r = -0.59，p < 0.0001），与峰值dP/dt也呈直接和反向相关（r = 0.75，p < 0.0001；r = -0.68，p < 0.0001）。室间隔的两个组织多普勒变量与%EF均无相关性，但与峰值dP/dt大致相关。我们得出结论，通过脉冲组织多普勒成像获得的左心室壁收缩期运动速度参数可能有助于对无节段性运动不协调患者的左心室整体收缩功能进行无创评估。
