冠心病患者不同左心室射血分数二尖瓣口E/Ea的观测意义

Significance of Mitral E/Ea Estimation in Cases of Coronary Heart Disease with Different Left Ventricular Ejection Fractions

摘要: 目的：了解冠心病患者不同心室收缩状态下二尖瓣口E/Ea的变化及观测意义。资料与方法：107例经冠脉造影确诊的冠心病按超声心动图测定的LVEF大小分为3组：LVEF > 50% 62例为I组，LVEF45%~50% 24例为II组，LVEF < 45% 21例为III组。观测指标主要包括：超声心动图心脏常规测量计算LVEF、二尖瓣口血流E/A比值、二尖瓣环舒张早期运动速度e波(Ea)、计算E/Ea比值及BNP。结果：III组的左心室内径明显大于I组、而其LVEF明显低于I组、II组，II组的LVEF也低于I组(p值均 < 0.05)；3组之间的E/A差异不显著，II组、III组之间的E/Ea差异不大(p > 0.05)，但是与I组比较则均有明显差异(p值均 < 0.05)；107例的BNP平均值较高，其中II组、III组明显高于I组，III组也高于II组；以107例为分析样本，E/Ea与BNP呈正相关，BNP与LVEF、E/Ea与LVEF则呈负相关(p值均 < 0.05)；在I组中也基本保持了这样的相关关系，而在II组、III组中，不论是E/Ea与BNP、BNP与LVEF，还是E/Ea与LVEF之间均未呈现明显的线性相关。结论：在较大的样本中E/Ea与LVEF及BNP表现出较为明确的线性相关，但也存在着E/Ea的变化程度与LVEF不一致的情况，说明冠心病患者可存在着左心室收缩障碍与舒张功能减低程度的不一致，需要结合患者临床和相关实验室检查加以综合判断。

Abstract: Object: To understand the changes and clinical meanings of mitral E/Ea in cases of coronary heart disease (CHD) with different systolic functions of left ventricle. Methods: According to LVEFs measured by echocardiography, 107 patients with CHD diagnosed by coronary arteriography were divided into three groups: 62cases of LVEF >50% in group I, 24 cases of LVEF 45%~50% in group II and 21 cases of LVEF < 45% in group III. Indications to be observed mainly included LVEF, ratio of mitral diaslotic early flow velocity E to mitral late flow velocity A (E/A), diaslotic early velocity wave of mitral anulus (e, Ea), ratio of E/Ea and levels of plasma Brain-type natriuretic peptide (BNP). Results: Diameters of left ventricle in group III were larger than those in group I, while LVEFs in group III were lower than those in group I and group II, with LVEFs in group II being lower than that in group I, too (all p < 0.05). Differences of E/A among the three groups and of E/Ea between group II and group III were not obvious(all p > 0.05), but ratios of E/Ea in group II and group III were higher than those in group I (both p < 0.05). The mean value of BNP in all the 107 cases was at a higher level, among which values of BNP in group II and group III were higher than those in group I, and the value of BNP in group III was also higher than that in group II (all p < 0.05). Based on analysis of all the 107 cases, there was a positive correlation between E/Ea and BNP, but there were negative correlations between BNP and LVEF and between E/Ea and LVEF (all p < 0.05). The similar linear correlations to those in all the 107cases were also seen in group I, however these correlations, including between E/Ea and BNP, BNP and LVEF as well as E/Ea and LVEF could not be found in group II and group III. Conclusions: Although there were clear correlations between E/Ea and both LVEF and BNP in analysis of a larger sample, there were some unidentical changes between E/Ea and LVEF, which showed that the lesions of systolic dysfunction could be inconsistent with those of diastolic dysfunction in some cases of CHD, and that the unidentical changes needed to be diagnosed by the clinical and laboratory data of the patients.