冠心病心脏舒张功能的多普勒超声心动图与左心导管法对比研究.docVIP

冠心病心脏舒张功能的多普勒超声心动图与左心导管法对比研究 　　作者：马国平,郭恒信,籍振国,刘刚,刘超,刘坤　　作者单位：050031 石家庄市，河北医科大学第一医院心内科(马国平、籍振国、刘刚、刘超、刘坤申);河北省石家市第三医院(郭恒信) 　　【摘要】 目的 通过无创伤超声心动图检查评价左心室舒张功能。方法 选择因反复胸痛行冠状动脉造影患者40例，经冠状动脉造影术确认分为无显著冠状动脉狭窄组和冠状动脉粥样硬化性心脏病(CHD)组，测量并记录左心室舒张末压(LVEDP)。经胸二维超声心动图检查，测量并记录超声心动图指标。结果 CHD组舒张早期二尖瓣血流速度 E 波与多普勒组织成像舒张早期二尖瓣环速度比值(E/Ea)(11.68±2.84)较无显著冠状动脉狭窄组E/Ea比值(8.60±1.90)增高(P0.05);CHD组LVEDP较无显著冠状动脉狭窄组明显增高(P0.05)。线性相关分析E/Ea与LVEDP呈正相关(r=0.8175，P0.05)。结论 严重的冠状动脉狭窄对左心室舒张功能有明显影响。在CHD中，E/Ea比值比E/A比值更能准确评价左心室舒张功能，尤其是预测LVEDP。 　　【关键词】 左心室舒张末压,冠心病,超声心动图 　　【Abstract】 Objective To evaluate the left ventricular end diastolic pressure(LVEDP)by echocardiographic findings.Methods Forty patients with repeated chest pain were divided into nonobvious coronary stenosis group and coronary heart disease (CHD) group according to the the examination results by coronary artery angiography.The LVEDP was detected and recorded,and the cardiac parameters were detected by thoracic 2dimensional echocardiography for both groups.Results The E/Ea ratio in CHD group was significantly higher than that in non-obvious coronary stenosis group(11.68±2.84 vs 8.60±1.90, P0.05). The LVEDP was significantly increased in CHD group,as compared with that in non-obvious coronary stenosis group(P0.05).The linear correlation was found between E/Ea ratio and LVEDP(r=0.8175, P0.05).Conclusion The severe coronary stenosis has a great influence on left ventricular diastolic function. In CHD patients, E/Ea is more accurate in the evaluation of left ventricular diastolic function,as compared with E/A, especially for the estimation of LVEDP. 　　【Key words】 left ventricular end diastolic pressure;coronary heart disease;Doppler echocardiography 　　近年来，左心室舒张功能的研究越来越受到重视。左心室舒张功能异常主要导致心室充盈受损或左心室舒张末压(LVEDP)增高，LVEDP被认为是评价左心室舒张功能的金标准，流行病学资料显示左心室舒张功能不全和舒张性心力衰竭患者占慢性充血性心力衰竭患者总数的40%～50%[1，2]，而这些患者的射血分数正常或相对正常。心血管病专家逐渐认识到：舒张功能异常也是心脏疾病发病和死亡的主要原因之一[3]，因此早期发现和准确评价左心室舒张功能障碍不仅能指导治疗，而且对改善预后有重大意义。我们收集了40例患者在冠状动脉造影时，用左心导管法确定LVEDP，与超声心动图指标相比较，评价