Utility of Doppler echocardiography and tissue Doppler imaging in the estimation of diastolic function in heart failure with normal ejection fraction -: A comparative Doppler-conductance catheterization study
Utility of Doppler echocardiography and tissue Doppler imaging in the estimation of diastolic function in heart failure with normal ejection fraction -: A comparative Doppler-conductance catheterization study
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DOI：
10.1161/circulationaha.106.661983
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发表时间：
2007-08-07
期刊：
影响因子：
37.8
通讯作者：
Tschope, Carsten
中科院分区：
文献类型：
--
作者：
Kasner, Mario;Westermann, Dirk;Tschope, Carsten
背景-比较各种常规和组织多普勒超声心动图指标与压力-容量环分析，以评价它们在检测射血分数(HFNEF)正常的心力衰竭患者左室舒张功能不全方面的准确性。方法和结果--43例(19名男性)HFNEF患者经电导导管测得的压力-容量环分析证实左室舒张功能不全。并与12例无心衰症状、射血分数正常的对照组进行比较。无创性测量的舒张期松弛指数(tau，dp/dt(Min))、左室舒张末压及左室舒张末压力-容量关系(硬度，b[dp/dv]和硬度常数，β)与常规二尖瓣血流和组织多普勒成像指标相关。常规多普勒指标与左心室舒张度指数tau(E/A：r=-0.36，P=0.013；等容松弛时间：r=0.31，P=0.040)和b(减速时间：r=0.39，P=0.012)呈中度相关，与β无相关性，而与组织多普勒成像指标E‘/A’(侧壁)(r=-0.37，P=0.008)和E/E‘(侧壁)(r=0.53，P<；0.001)相关。二尖瓣充盈指数E/E‘(侧壁)和E/E’(侧壁)分别为81%和86%。结论在所有超声心动图参数中，LV充盈指数E/E‘(侧壁)是反映HFNEF患者舒张期功能障碍的最佳指标，电导导管分析可明确诊断为舒张期功能障碍。我们建议将其作为无创性诊断HFNEF患者舒张期功能的重要工具。
Background - Various conventional and tissue Doppler echocardiographic indexes were compared with pressure - volume loop analysis to assess their accuracy in detecting left ventricular (LV) diastolic dysfunction in patients with heart failure with normal ejection fraction (HFNEF).Methods and Results - Diastolic dysfunction was confirmed by pressure - volume loop analysis obtained by conductance catheter in 43 patients (19 men) with HFNEF. Their Doppler indexes were compared with those of 12 control patients without heart failure symptoms and with normal ejection fraction. Invasively measured indexes for diastolic relaxation (tau, dP/dt(min)), LV end-diastolic pressure, and LV end-diastolic pressure-volume relationship (stiffness, b [dP/dV], and stiffness constant, beta) were correlated with several conventional mitral flow and tissue Doppler imaging indexes. Conventional Doppler indexes correlated moderately with the degree of LV relaxation index, tau (E/A: r = - 0.36, P = 0.013; isovolumic relaxation time: r = 0.31, P = 0.040) and b (deceleration time: r = 0.39, P = 0.012) but not with beta, in contrast to the tissue Doppler imaging indexes E'/A' (lateral) (r= -0.37, P = 0.008) and E/E'(lateral) (r = 0.53, P < 0.001). Diastolic dysfunction was detected in 70% of the HFNEF patients by mitral flow Doppler but in 81% and 86% by E'/A'(lateral), and E/E'(lateral), respectively.Conclusions - Of all echocardiographic parameters investigated, the LV filling index E/E'(lateral) was identified as the best index to detect diastolic dysfunction in HFNEF in which the diagnosis of diastolic dysfunction was confirmed by conductance catheter analysis. We recommend its use as an essential tool for noninvasive diagnostics of diastolic function in patients with HFNEF.