【罂粟摘要】应用经食道和经胸超声心动图的组织多普勒和斑点追踪技术评估左心室舒张早期血流速度
应用经食道和经胸超声心动图的组织多普勒和斑点追踪技术评估左心室舒张早期血流速度
贵州医科大学 高鸿教授课题组
翻译：潘志军 编辑：佟睿 审校：曹莹
评估舒张功能障碍是必要的且应该成为每次常规超声心动图检查的一部分。然而，临床医生在麻醉状态下通过经食道超声心动图(TEE)常规观察到的二尖瓣环速度低于清醒状态下经胸超声心动图(TTE)描述的速度。所以，重要的是要知道这种差异在恒定负载条件下是否持续存在。我们假设，在不变或恒定负载条件下，通过组织多普勒成像(TDI，E'TDI)测量的平均舒张早期二尖瓣环速度经食道中段4腔心切面(ME 4Ch)中与经心尖4腔心切面(AP 4Ch)中不同。其次，在假定具有优越的多普勒波束对准、经腹深层视图(DTG)下，我们在另一种经食道切面检测了E'TDI，同法并与AP 4Ch对比。我们还检测了在ME 4Ch和AP 4Ch中基于舒张早期斑点追踪的应变率（E'SR）。
纳入了2017年2月至7月期间接受体外循环心脏手术的25例成人患者。在麻醉下以随机顺序获得在AP 4Ch、ME 4Ch和DTG视图中TTE和TEE的测量值。通过配对t检验和Bonferroni调整比较患者内的平均数。使用Bland-Altman 的箱线图、相关性和一致性对上述3个比较进行检查。接着再一次使用超声心动图独立采集和分析图像，并在4周后重新分析图像。同时还报告了图像质量和再现性。
ME 4Ch的平均E'TDI测量值低于AP 4Ch（6.6±1.7 cm/s vs 7.0±1.5 cm，P=0.028；患者自身差异的均数±标准差：0.6±1.2 cm/s）。E'TDI的另一种TEE视图DTG也表现出较低的平均数（6.0±1.6 cm/s，P=0.006；患者自身差异的均数±标准差：1.1±1.8 cm/s）。E'SR应变率显示出较低程度的偏差，但变异性更大（ME 4Ch：0.87±0.32%/s与AP 4Ch：0.73±0.18%/s，P=0.078；患者自身差异的均数±标准差：- 0.1±0.2%/s)。
这项研究证实，虽然TEE在一定程度上低估了E'TDI，但没有达到临床相关程度。虽然在DTG中E'TDI不是一个有前途的替代方案，但基于斑点追踪的舒张早期应变率的未来作用尚不清楚。
Eckhard Mauermann, Stefaan Bouchez, Thierry Bove, et al. Assessing Left Ventricular Early Diastolic Velocities With Tissue Doppler and Speckle Tracking by Transesophageal and Transthoracic Echocardiography. [J].(Anesth Analg 2021;132:1400–9).
Assessing Left Ventricular Early Diastolic Velocities With Tissue Doppler and Speckle Tracking by Transesophageal and Transthoracic Echocardiography
Background: Assessing diastolic dysfunction is essential and should be part of every routine echocardiography examination. However, clinicians routinely observe lower mitral annular velocities by transesophageal echocardiography (TEE) under anesthesia than described by awake transthoracic echocardiography (TTE). It would be important to know whether this difference persists under constant loading conditions. We hypothesized that mean early diastolic mitral annular velocity, measured by tissue Doppler imaging (TDI,E'TDI) would be different in the midesophageal 4-chamber (ME 4Ch) than in the apical 4-chamber (AP 4Ch) view under unchanged or constant loading conditions. Secondarily we examined (1) E'TDI in an alternative transesophageal view with presumed superior Doppler beam alignment, the deep transgastric view (DTG), compared to those in the AP 4Ch, and (2) early diastolic speckle tracking-based strain rate (E'SR), in the ME 4Ch and in the AP 4Ch.
Methods: Twenty-five consecutive adult patients undergoing on-pump cardiac surgery from February 2017 to July 2017 were included. Both TTE and TEE measurements were obtained under anesthesia in a randomized order in the AP 4Ch, ME 4Ch, and DTG views. Within-patient average values were compared by paired t tests with a Bonferroni adjustment. Box plots, correlation, and agreement by Bland-Altman were examined for all 3 comparisons. A second echocardiographer independently acquired and analyzed images; images were reanalyzed after 4 weeks. Image quality and reproducibility were also reported.
Results: Averaged E'TDI measurements were lower in the ME 4Ch than in the AP 4Ch (6.6±1.7 cm/s vs 7.0±1.5 cm, P=0.028; within-patient difference mean±standard deviation: 0.6±1.2 cm/s). An alternative TEE view for E'TDI, the DTG, also exhibited lower mean values (6.0±1.6 cm/s, P=0.006; within-patient difference mean±standard deviation: 1.1±1.8 cm/s). E'SR strain rate showed a low degree of bias, but greater variability (ME 4Ch: 0.87±0.32%/s vs AP 4Ch:0.73±0.18%/s, P=0.078; within-patient difference mean±standard deviation: −0.1±0.2%/s).
Conclusions: This study confirms that TEE modestly underestimates E'TDI but not to a clinically relevant extent. While E'TDI in the DTG is not a promising alternative, the future role for speckle tracking-based early diastolic strain rate is unknown.