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目的:探讨首次急性心肌梗死(AMI)患者Tei指数与左心室充盈模式及预后的关系。方法:对165例AMI患者的超声心动图参数进行检测。由二尖瓣及左心室流出道多普勒血流频谱曲线测定左心室等容舒张时间(IRT)、等容收缩时间(ICT)及左心室射血时间(ET)。左心室Tei指数=(ICT+IRT)/ET。依据二尖瓣E波减速时间(EDT)和左心室舒张早期血流传播速度(Vp)将165例AMI患者分为正常充盈组、松弛性减低组、假性正常化组、限制性充盈组。应用Cox比例风险模型分析患者远期存活的风险预测。结果:165例AMI患者中,正常充盈43例、松弛性减低55例、假性正常化35例、限制性充盈32例。与正常充盈组比较,松弛性减低组、假性正常化组、限制性充盈组的Tei指数增大(P<0.05～0.01);限制性充盈组的左心室舒张末期容积指数(EDVI)和收缩末期容积指数(ESVI)增加(P<0.05～0.01)。平均随访12(0～17)个月时,22例患者死亡。死亡组的Tei指数与生存组的Tei指数比较,差异有显著性意义(P<0.01)。Cox模型生存分析显示Tei指数≥0.6为死亡的独立危险因子(相对危险系数为3.997,P=0.028)。结论:AMI患者Tei指数与左心室充盈模式有关,能够反映左心室功能障碍的严重程度,是AMI后患者死亡的独立预测因子。
Objective: To investigate the relationship between Tei index and left ventricular filling pattern and prognosis in patients with first acute myocardial infarction (AMI). Methods: The echocardiographic parameters of 165 AMI patients were examined. Left ventricular isovolumic relaxation time (IRT), isovolumic systolic time (ICT) and left ventricular ejection time (ET) were measured by Doppler flow spectrum of mitral valve and left ventricular outflow tract. Tei index of left ventricle = (ICT + IRT) / ET. 165 AMI patients were divided into normal filling group, relaxation relaxation group, pseudo-normal group and restrictive filling group according to mitral E-wave deceleration time (EDT) and early left ventricular diastolic blood flow velocity (Vp). The risk prediction of long-term survival in patients was analyzed using the Cox proportional hazards model. Results: Of 165 patients with AMI, 43 cases were normal filling, 55 cases were reduced relaxation, 35 cases were pseudo-normalization and 32 cases were limited filling. Compared with the normal filling group, the Tei index of the relaxation reduced group, the pseudo normalization group and the limited filling group increased (P <0.05-0.01); the left ventricular end-diastolic volume index (EDVI) and contraction Terminal volume index (ESVI) increased (P <0.05 ~ 0.01). Twenty-two patients died at mean follow-up of 12 (0-17) months. There was a significant difference between the Tei index of death group and Tei index of survival group (P <0.01). Cox model survival analysis showed that the Tei index ≥0.6 was an independent risk factor for death (relative risk coefficient was 3.997, P = 0.028). CONCLUSIONS: The Tei index in patients with AMI correlates with left ventricular filling pattern to reflect the severity of left ventricular dysfunction and is an independent predictor of mortality in patients with AMI.