摘要
目的：采用组织多普勒成像(TDI)技术定量测量冠心病心肌缺血患者的二尖瓣环及左室各节段室壁运动速度，观察左室整体和局部功能。
方法：随机入选因胸痛被拟诊冠心病心肌缺血而入院的患者81例，所有患者在行冠脉造影检查前均行普通超声心动图检查和左室各室壁节段心肌及二尖瓣环组织多普勒成像技术(TDI)检查，通过冠脉造影确定冠心病组患者45例，对照组患者36例，分别比较结果。所有各项指标均以统一标准严格测定。
结果：
1．所有患者均经普通超声测定左房前后径，左室舒末径和左室缩末径，室间隔厚度，二尖瓣口血流速度E和A，并计算E／A，Simpision's法测定左室射血分数(LVEF)(表2)。
2．所有患者左室心肌各节段运动在TDI有明显的特征，每个心动周期中，均包括收缩波(s)，快速充盈波(e)，和左房收缩充盈波(a)，三个主要波形(见图4)。
3．冠心病组和对照组在心尖四腔心切面：左室间隔壁中段、基底段，侧壁中段、基底段；心尖二腔心切面：左室下壁中段、基底段，前壁中段、基底段，心肌运动速度测值比较(表4-7)经t检验两两比较提示：冠心病组室壁节段的收缩速度(Vs)较对照组无明显降低，舒张晚期运动峰速度(Va)两组比较变化不明显，而舒张早期运动峰速度(Ve)及舒张早期运动峰速度
天津医科大学硕.士研究生学七立论文
(Ve)与舒张晚期运动峰速度(Va)的比值均显著低于对照组相应节段。
4.冠心病组和对照组在心尖四腔心切面:侧壁及间隔壁，心尖二腔心切
面:前壁及下壁，心尖长轴心切面前间隔和后壁，分别用‘IJ)l测定三尖瓣环
上这6个位点收缩期运动峰速度(Vs)，舒张早期运动峰速度(Ve)心房收缩
峰速度(Va)，并计算出其平均值及Ve，Va，并分别比较(表3)提示冠心病组
患者舒张早期运动峰速度(Ve)心房收缩峰速度(Va)，及VeVa显著低于对
照组，而收缩期运动峰速度(VS)无明显变化。.
5.将冠心病组患者按相应冠脉狭窄程度进一步分组比较，以冠脉狭窄)
70%为标准，严重LAD称病变冠心病患者其间壁中间段及前壁心肌的VS、Ve、
Ve/Va均明显低于对照组，差异显著(P<0.05);严重LCx病变冠心病患者
其侧壁心肌的Vs、Ve、Ve/Va均明显低于对照组差异显著(P<0.05);严重
RCA病变冠心病患者其间壁基底段及下壁心肌的VS、Ve、Ve/Va均明显低于对
照组，差异显著印<0.05)。
结论:
1.冠心病组左室局部心肌舒张功能异常的出现早于局部心肌收缩功能异
常‘l’01直观、定量显示左室早期局部心肌舒张功能异常，对冠心病早期无创
性诊断具有重要的应用价值。
2.TDI亦能测定严重缺血的心肌节段收缩功能异常。
3.冠心病组左室整体舒张功能的异常出现早于整体收缩功能异常，‘fDI
测定二尖瓣环舒张期运动参数可作为评价冠心病左室舒张功能的指标。
Objective: To evaluate the clinical value of Tissue doppler imaging(TDI) in quantitative detection of regional and global of left ventricular systolic and diastolic function in patients with coronary artery disease .
Methods: Random examination was performed on 81 in hospital. By angiography of coronary artery, we confirm 45 patients(CAD) and 36 control subjests. Tissue Doppler imaging (TDI) is an ultrasonic technique that can be applied to analyse myocardial motion objectively and quantitatively. With pulsed-wave TDI myocardial motion velocity can be measured directly. In this, study ,we also analyse mitral annular velocity in systolic and diastole in all patients by TDI, to assess left ventricular function. Results:
1. There are three peaks in all patients include systolic velocity(Vs),early diastolic velocity(Ve),late diastolic velocity(Va).
2. Using color Doppler echocardiography, LV structural parameters and systolic parameters had no change between two groups. LV filling parameter were significantly different in the CAD,peak velocity of late filling were higher, ratio of early/late filling velocity were lower, but peak velocity of early filling had no change.
3. With TDI mitral annular motion velocity was measured. There were significantly different in mitral annular peak early diastolic velocity (Ve),peak
late diastolic velocity(Va),and ratio of peak early/late diastolic velocity, except systolic velocity(Vs).
4. With TDI myocardial wall velocity was measured. There were significantly
different in peak early diastolic velocity (Ve),peak late diastolic velocity(Va),and ratio of peak early/late diastolic velocity, except systolic velocity(Vs).
5. TDI also can image the regional myocardial systolic velocity especially in ischemic myocardium.
Conclusions:
1. Our study shows that TDI is a simple, correct and practical method in evaluation of left ventricular diastolic function, regional diastolic function in ischemic myocardium.
2. There are difference in left ventricular diastolic function, regional systolicand diastolic function between CAD and Con-groups.
3. TDI can be used in no-intervention diagnosing CAD.
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