中国医学影像技术
中國醫學影像技術
중국의학영상기술
CHINESE JOURNAL OF MEDICAL IMAGING TECHNOLOGY
2009年
10期
1785-1788
,共4页
贺声%沈燕华%李馨%杨京伟%张云山%任贺
賀聲%瀋燕華%李馨%楊京偉%張雲山%任賀
하성%침연화%리형%양경위%장운산%임하
二尖瓣口%二尖瓣环%超声检查%多普勒%脉冲%左心室充盈压
二尖瓣口%二尖瓣環%超聲檢查%多普勒%脈遲%左心室充盈壓
이첨판구%이첨판배%초성검사%다보륵%맥충%좌심실충영압
Transmitral%Mitral annulus%Ultrasonography%Doppler%pulsed%Left ventricular filling pressures
目的 了解二尖瓣口血流波形与二尖瓣环多普勒组织成像(DTI)波形测量结果不一致性在评价左心室舒张功能中的临床意义.方法 对182例窦性心律患者行常规超声心动图检查,同步心电图记录.于心尖四腔、心尖三腔、心尖二腔切面分别测量二尖瓣环室间隔、左心室侧壁、前间隔、左心室后壁、左心室前壁及下壁6个位点的DTI舒张期波形;于心尖四腔切面测量二尖瓣口舒张期波形;计算MV-E/A、DTI-e/a-ann及E/e-ann, e-ann为6个位点的平均值.结果 182例患者中,依二尖瓣口血流和6个位点二尖瓣环波形的测量结果分成4组,组Ⅰ:MV-E/A＜1.0,同时6个位点DTI-e/a-ann均＜1.0,共68例,MV-E/A为0.71±0.16、E/e-ann为15.91±6.78;组Ⅱ:MV-E/A＜1.0,同时6个位点中有1～6个位点的DTI-e/a-ann≥1.0,共38例,MV-E/A为0.76±0.12、E/e-ann为10.37±2.63;组Ⅲ:MV-E/A≥1.0,同时6个位点的DTI-e/a-ann均≥1.0,共23例, MV-E/A为1.74±0.42、E/e-ann为9.57±2.39;组Ⅳ:MV-E/A≥1.0,同时6个位点中有1～6个位点的DTI-e/a-ann＜1.0,共53例, MV-E/A为1.31±0.31、E/e-ann为13.27±9.46.组Ⅰ、Ⅱ、Ⅳ的平均年龄均大于组Ⅲ(P＜0.05),组Ⅰ与组Ⅱ的平均年龄和MV-E/A基本相同(P＞0.05),但组Ⅰ的平均E/e-ann明显高于组Ⅱ(P＜0.05);组Ⅲ与组Ⅳ比较,两者的MV-E/A差别不大(P＞0.05),但后者的年龄、E/e-ann均大于前者(P＜0.05);组Ⅰ、组Ⅱ与组Ⅳ之间,组Ⅳ的平均年龄小于组Ⅰ与组Ⅱ,但组Ⅳ的E/e-ann小于组Ⅰ而大于组Ⅱ(P＜0.05).结论 ①MV-E/A＜1.0伴有6个位点DTI-e/a-ann均＜1.0提示左心室充盈压较高;②MV-E/A≥1.0,同时6个位点中有1～6个位点的DTI-e/a-ann＜1.0者有左心室充盈压较高的倾向;③MV-E/A＜1.0,同时6个位点中有1～6个位点的DTI-e/a-ann≥1.0或MV-E/A≥1.0或同时6个位点的DTI-e/a-ann均≥1.0者的左心室充盈压可能有较大变数;④年龄对MV-E/A和DTI-e/a-ann测值有较大影响.
目的 瞭解二尖瓣口血流波形與二尖瓣環多普勒組織成像(DTI)波形測量結果不一緻性在評價左心室舒張功能中的臨床意義.方法 對182例竇性心律患者行常規超聲心動圖檢查,同步心電圖記錄.于心尖四腔、心尖三腔、心尖二腔切麵分彆測量二尖瓣環室間隔、左心室側壁、前間隔、左心室後壁、左心室前壁及下壁6箇位點的DTI舒張期波形;于心尖四腔切麵測量二尖瓣口舒張期波形;計算MV-E/A、DTI-e/a-ann及E/e-ann, e-ann為6箇位點的平均值.結果 182例患者中,依二尖瓣口血流和6箇位點二尖瓣環波形的測量結果分成4組,組Ⅰ:MV-E/A＜1.0,同時6箇位點DTI-e/a-ann均＜1.0,共68例,MV-E/A為0.71±0.16、E/e-ann為15.91±6.78;組Ⅱ:MV-E/A＜1.0,同時6箇位點中有1～6箇位點的DTI-e/a-ann≥1.0,共38例,MV-E/A為0.76±0.12、E/e-ann為10.37±2.63;組Ⅲ:MV-E/A≥1.0,同時6箇位點的DTI-e/a-ann均≥1.0,共23例, MV-E/A為1.74±0.42、E/e-ann為9.57±2.39;組Ⅳ:MV-E/A≥1.0,同時6箇位點中有1～6箇位點的DTI-e/a-ann＜1.0,共53例, MV-E/A為1.31±0.31、E/e-ann為13.27±9.46.組Ⅰ、Ⅱ、Ⅳ的平均年齡均大于組Ⅲ(P＜0.05),組Ⅰ與組Ⅱ的平均年齡和MV-E/A基本相同(P＞0.05),但組Ⅰ的平均E/e-ann明顯高于組Ⅱ(P＜0.05);組Ⅲ與組Ⅳ比較,兩者的MV-E/A差彆不大(P＞0.05),但後者的年齡、E/e-ann均大于前者(P＜0.05);組Ⅰ、組Ⅱ與組Ⅳ之間,組Ⅳ的平均年齡小于組Ⅰ與組Ⅱ,但組Ⅳ的E/e-ann小于組Ⅰ而大于組Ⅱ(P＜0.05).結論 ①MV-E/A＜1.0伴有6箇位點DTI-e/a-ann均＜1.0提示左心室充盈壓較高;②MV-E/A≥1.0,同時6箇位點中有1～6箇位點的DTI-e/a-ann＜1.0者有左心室充盈壓較高的傾嚮;③MV-E/A＜1.0,同時6箇位點中有1～6箇位點的DTI-e/a-ann≥1.0或MV-E/A≥1.0或同時6箇位點的DTI-e/a-ann均≥1.0者的左心室充盈壓可能有較大變數;④年齡對MV-E/A和DTI-e/a-ann測值有較大影響.
목적 료해이첨판구혈류파형여이첨판배다보륵조직성상(DTI)파형측량결과불일치성재평개좌심실서장공능중적림상의의.방법 대182례두성심률환자행상규초성심동도검사,동보심전도기록.우심첨사강、심첨삼강、심첨이강절면분별측량이첨판배실간격、좌심실측벽、전간격、좌심실후벽、좌심실전벽급하벽6개위점적DTI서장기파형;우심첨사강절면측량이첨판구서장기파형;계산MV-E/A、DTI-e/a-ann급E/e-ann, e-ann위6개위점적평균치.결과 182례환자중,의이첨판구혈류화6개위점이첨판배파형적측량결과분성4조,조Ⅰ:MV-E/A＜1.0,동시6개위점DTI-e/a-ann균＜1.0,공68례,MV-E/A위0.71±0.16、E/e-ann위15.91±6.78;조Ⅱ:MV-E/A＜1.0,동시6개위점중유1～6개위점적DTI-e/a-ann≥1.0,공38례,MV-E/A위0.76±0.12、E/e-ann위10.37±2.63;조Ⅲ:MV-E/A≥1.0,동시6개위점적DTI-e/a-ann균≥1.0,공23례, MV-E/A위1.74±0.42、E/e-ann위9.57±2.39;조Ⅳ:MV-E/A≥1.0,동시6개위점중유1～6개위점적DTI-e/a-ann＜1.0,공53례, MV-E/A위1.31±0.31、E/e-ann위13.27±9.46.조Ⅰ、Ⅱ、Ⅳ적평균년령균대우조Ⅲ(P＜0.05),조Ⅰ여조Ⅱ적평균년령화MV-E/A기본상동(P＞0.05),단조Ⅰ적평균E/e-ann명현고우조Ⅱ(P＜0.05);조Ⅲ여조Ⅳ비교,량자적MV-E/A차별불대(P＞0.05),단후자적년령、E/e-ann균대우전자(P＜0.05);조Ⅰ、조Ⅱ여조Ⅳ지간,조Ⅳ적평균년령소우조Ⅰ여조Ⅱ,단조Ⅳ적E/e-ann소우조Ⅰ이대우조Ⅱ(P＜0.05).결론 ①MV-E/A＜1.0반유6개위점DTI-e/a-ann균＜1.0제시좌심실충영압교고;②MV-E/A≥1.0,동시6개위점중유1～6개위점적DTI-e/a-ann＜1.0자유좌심실충영압교고적경향;③MV-E/A＜1.0,동시6개위점중유1～6개위점적DTI-e/a-ann≥1.0혹MV-E/A≥1.0혹동시6개위점적DTI-e/a-ann균≥1.0자적좌심실충영압가능유교대변수;④년령대MV-E/A화DTI-e/a-ann측치유교대영향.
Objective To explore the clinical significance of the disagreement between transmitral pulsed wave Doppler (PWD) and mitral annulus Doppler tissue imaging (DTI) in the estimation of left ventricular (LV) filling pressures. Methods One hundred and eighty-two sinus rhythm patients without arrhythmia, congenital heart disease and valvular disease underwent routine echocardiography and synchronous electrocardiogram for assessment of LV function. Early and late diastolic velocities of LV, which were composed of e and a waves, were recorded using DTI at the mitral annulus. Six sites at the mitral annuli were selected corresponding to the septal, lateral, anterior septal, posterior, inferior, and anterior walls of LV from apical 4-, 3-and 2-chamber views. Transmitral diastolic flow velocity, which was represented by E and A wave, was measured with PWD from apical 4-chamber view. Ratio of early and late diastolic transmitral valve (MV-E/A), ratio of DTI-e/a-ann and ratio of E/e-ann were calculated, respectively. The mean value of e-ann from the above 6 sites was selected to describe the early diastolic velocities of mitral annular. Results According to the results of MV-E/A ratio and DTI-e/a-ann ratios of the 6 sites, these 182 patients were divided into 4 groups: groupⅠ(n=68): MV-E/A＜1.0, DTI-e/a-ann＜1.0 at all the 6 sites at the same time, with mean MV-E/A ratio being 0.71±0.16 and mean E/e-ann ratio 15.91±6.78; groupⅡ(n=38): MV-E/A＜1.0, DTI-e/a-ann≥1.0 at 1-6 sites among the total sites, with mean MV-E/A ratio being 0.76±0.12 and mean E/e-ann ratio 10.37±2.63; group Ⅲ(n=23): MV-E/A≥1.0, DTI-e/a-ann≥1.0 at all the 6 sites at the same time, with mean MV-E/A ratio being 1.74±0.42 and mean E/e-ann ratio 9.57±2.39; group Ⅳ(n=53): MV-E/A≥1.0, DTI-e/a-ann＜1.0 at 1-6 sites among the total sites, with mean MV-E/A ratio being 1.31±0.31 and mean E/e-ann ratio 13.27±9.46. The mean ages of group Ⅰ, Ⅱand Ⅳ were older than that of group Ⅲ. Although there was no obvious difference between group Ⅰand groupⅡ in the mean age and mean MV-E/A (P＞0.05), the mean E/e-ann was much higher in group Ⅰthan that in groupⅡ (P＜0.05). The mean MV-E/A was similar in group Ⅲ and group Ⅳ (P＞0.05), but the mean age and mean E/e-ann in the latter were older and higher than those in the former (P＜0.05), respectively. The mean age in group Ⅳ was younger than that in group Ⅰand Ⅱ, while the mean E/e-ann in group Ⅳ was higher than that in group Ⅱ, but lower than group Ⅰ (P＜0.05). Conclusion ①Ratio of MV-E/A ＜1.0 and ratios of DTI-e/a-ann ＜1.0 at all the 6 sites indicates increasing LV filling pressures; ②MV-E/A≥1.0 and DTI-e/a-ann＜1.0 at 1-6 sites among the total sites predicts a tendency of high LV filling pressures; ③Wide variability may present in those with MV-E/A＜1.0, DTI-e/a-ann≥1.0 at 1-6 sites among the total 6 sites or MV-E/A≥1.0, DTI-e/a-ann≥1.0 at all the 6 sites at the same time; ④Age of the patient has great influence on the measurement of MV-E/A ratio and DTI-e/a-ann ratio.
