Derumeaux G, Douillet R, Redonnet M, Mouton-Schleifer D, Soyer R, Cribier A, Letac B
Service de cardiologie, hôpital Charles-Nicolle, Rouen.
Arch Mal Coeur Vaiss. 1998 Oct;91(10):1255-62.
Doppler tissue imaging is a new technique of measuring the velocities of myocardial wall motion. In order to assess its value in the diagnosis of acute rejection, the velocities of the interventricular septum and left ventricular posterior wall were measured in systole and early diastole in 34 cardiac transplant patients at the time of their endomyocardial biopsy, using an M mode left parasternal short axis view. During 40 episodes of acute rejection (26 mild and/or moderate, 10 sub-severe and 4 severe), the wall velocities decreased significantly (p < 0.001) both in the interventricular septum and endocardium of the posterior wall. Myocardial velocities were significantly slower in sub-severe or severe rejection than in mild or moderate rejection. The most sensitive criterion was the measurement of posterior wall endocardial velocity in early diastole, a decrease of 10% having a sensitivity of 92% whereas the sensitivity of usual Doppler echocardiographic parameters is only 73%. Acute rejection, even mild cases, can be diagnosed with excellent sensitivity by measuring myocardial velocities by Doppler tissue imaging. This technique has the advantage of being non-invasive, reproducible and reliable in the follow-up of cardiac transplant patients.
多普勒组织成像技术是一种测量心肌壁运动速度的新技术。为了评估其在急性排斥反应诊断中的价值，在34例心脏移植患者进行心内膜心肌活检时，采用M型胸骨旁左室短轴观，测量了其在收缩期和舒张早期室间隔及左室后壁的运动速度。在40次急性排斥反应发作期间（26次轻度和/或中度、10次亚重度和4次重度），室间隔和后壁心内膜的壁运动速度均显著下降（p<0.001）。亚重度或重度排斥反应时的心肌运动速度明显慢于轻度或中度排斥反应。最敏感的标准是测量舒张早期后壁心内膜速度，下降10%时敏感性为92%，而常规多普勒超声心动图参数的敏感性仅为73%。通过多普勒组织成像测量心肌运动速度，即使是轻度急性排斥反应也能以极高的敏感性被诊断出来。这项技术具有无创、可重复且在心脏移植患者随访中可靠的优点。
