CAJ | 학술논문

目的：探讨双脉冲多普勒超声心动图技术测量舒张早期二尖瓣血流E波开始时间与舒张早期二尖瓣瓣环e’波开始时间差值TE-e’，评估TE-e’诊断左心室舒张功能不全准确性。方法连续入组冠心病患者77例，所有患者均行冠脉造影，心导管测量左心室舒张末压力（LVEDP）；双脉冲多普勒技术测量舒张早期二尖瓣血流峰值速度E与舒张早期二尖瓣瓣环峰值速度e’，计算E/e’与TE-e’，评估左心室舒张末压力与TE-e’相关性及E/e’、TE-e’与TE-e’联合E/e’，诊断左心室舒张末功能不全[指左心室舒张末期压力≥12 mmHg（1 mmHg=0.133 kPa）]的准确性。结果1、左心室舒张末压（LVEDP）与TE-e’，E/e’相关性分别为r=0.42和r=0.79，P<0.001；2、TE-e’≥38 ms时，诊断左心室舒张功能不全的敏感性为54%，特异性为79%，ROC曲线下面积0.71。E/e’≥9.2时，诊断左心室舒张功能不全敏感性为74%，特异性为81%，ROC曲线下面积0.87；3、联合E/e’≥9.2，TE-e’≥38 ms诊断左心室舒张功能不全敏感性为100%，特异性为62%，ROC曲线下面积0.96。结论双脉冲多普勒技术测量TE-e’为评估左心室舒张功能不全的有效指标，联合E/e’能够提高诊断左心室舒张功能不全的准确性。
목적：탐토쌍맥충다보륵초성심동도기술측량서장조기이첨판혈류E파개시시간여서장조기이첨판판배e’파개시시간차치TE-e’，평고TE-e’진단좌심실서장공능불전준학성。방법련속입조관심병환자77례，소유환자균행관맥조영，심도관측량좌심실서장말압력（LVEDP）；쌍맥충다보륵기술측량서장조기이첨판혈류봉치속도E여서장조기이첨판판배봉치속도e’，계산E/e’여TE-e’，평고좌심실서장말압력여TE-e’상관성급E/e’、TE-e’여TE-e’연합E/e’，진단좌심실서장말공능불전[지좌심실서장말기압력≥12 mmHg（1 mmHg=0.133 kPa）]적준학성。결과1、좌심실서장말압（LVEDP）여TE-e’，E/e’상관성분별위r=0.42화r=0.79，P<0.001；2、TE-e’≥38 ms시，진단좌심실서장공능불전적민감성위54%，특이성위79%，ROC곡선하면적0.71。E/e’≥9.2시，진단좌심실서장공능불전민감성위74%，특이성위81%，ROC곡선하면적0.87；3、연합E/e’≥9.2，TE-e’≥38 ms진단좌심실서장공능불전민감성위100%，특이성위62%，ROC곡선하면적0.96。결론쌍맥충다보륵기술측량TE-e’위평고좌심실서장공능불전적유효지표，연합E/e’능구제고진단좌심실서장공능불전적준학성。
Objective To evaluate the accuracy of the time interval between the onset of early transmitral flow velocity (E) and that of early diastolic mitral annular velocity (e') (TE- e') measured by dual Doppler echocardiography in the diagnosis of diastolic dysfunction. Methods Seventy-seven coronary heart disease patients with preserved systolic function underwent a echocardiographic study. Early transmitral flow velocity E and early diastolic mitral annular velocity e' were simultaneously recorded by dual Doppler echocardiography. The E/e' and TE-e' were calculated and compared with the left ventricular end diastolic pressure (LVEDP), which was measured invasively. The validity of TE-e', E/e' and their combination was analyzed in estimating left ventricular dysfunction (LVEDP ≥12 mmHg). Results The single-beat E/e' and TE-e' were correlated with the LVEDP (r=0.79 and 0.42, respectively, P<0.001). Receiver-operating characteristic analysis showed that the optimal cut-off for TE-e' was 38 ms (sensitivity 54%, specificity 79%, AUC 0.71) and that for E/e' was 9.2 (sensitivity 74%, specificity 81%, AUC 0.87) for diagnosis of left ventricular diastolic dysfunction. The combined cut-offs of TE-e'≥38 ms and E/e'≥9.2 had a sensitivity of 100%and a specificity of 62%in diagnosing left ventricular diastolic dysfunction with an AUC of 0.96. Conclusion In patients with coronary heart disease, the simultaneous recording of TE-e' by dual Doppler echocardiography can accurately estimate diastolic dysfunction, and its combination with E/e' can further improve the diagnostic accuracy.