9. Levy D, Garrison RJ, Sava^.^' D D ot al. 10. Verma A, Meris A, Skali H, et al. (2008).
( 1 9 9 0 ) . P r o g n o s t i c i m p l i c a t i o n s of Prognostic implicatidns of left ventricular mass and echocardiographically determined left ventricular geometry following myocardial infarction: the mass in the Framingham Heart Study. New Engl J VALIANT (Valsartan in acute myocardial Med; 322: 1561 - 6. infarction) Echocardiographie study. J Am Col
Cardiol Cardiovase Imaging. Sep; 1 (1 5): 592 - 4.
Summary
PROGNOSTIC IMPLICATIONS OF LEFT VENTRICULAR HYPERTROPHY FOLLOWING ACUTE MYOCARDIAL INFARCTION
Objectives: To determine the progndstic impact of left ventricular hypertrophy on cardiovascular events for patients with a first, uncomplicated acute myocardial infarction (AMI). Methods: 98 consecutive patients had an echocardiographie examination at prediseharge. Left ventricular mass (LV mass) was calculated by means of Devereux's formula and subsequently indexed by body surface area. Results: 45 patients had LV hypertrophy and 53 patients had normal LV mass. The two groups were homogeneous for clinical and angiographic variables. During follow - up period, there were 20 cardiac events in patients group with LV hypertrophy and only 6 events in the patients group without LV hypertrophy (RR = 4.17;
95%C1 = 1.63 - 11.31; p < 0.001). The patients with concentric LV hypertrophy showed a higher rate of events than patients with eccentric LV hypertrophy (52% versus 2 0 % , p < 0.05) and patients with normal geometry and mass (52% vesus 1 7%, p < 0.01). Concentric LV hypertrophy, eccentric LV hypertrophy carry the risks of cardiovascular events [RR: 4.34 (0.97 - 10.8) and 2.07 (0.92 - 8.76), respectively].
Conclusion: an increased LV mass (concentric and eccentric LV hypertrophy) resulted important markers of an adverse outcome in patients with a first, uncomplicated myocardial infarction.
Keywords: left ventricular hypertrophy, acute myocardial infarction
DANH GIA CHLfC NANG THAT PHAI BANG CHI SO TEI TREN SIEU AM DOPPLER TIM 6 BENH NHAN HEP KHIT VAN HAI LA
Nguyen Lan Vict, Nguyen Thj Bach Yen Trddng Dai hoc Y hia Noi Chi sd chdc nang ca tim (MPI) - cdn gcii la chi sd Tel (chi sd do tren sieu am Doppler tim: ty le gida long Ihdi gian gian dong the tich va thdi gian co dong the tich chia cho thdi gian tdng mau) la mdt thdng sd cho phep danh gia kha chinh xac chdc nang toan bo cua tam that (ca chdc nang tam thu va chdc nang tam trddng). Muc tieu: dng dung chi sd Tei trong danh gia chdc nang toan bd that phai d benh nhan HHL kbit vii tim hieu mdi Iddng quan gida chi sd Tei vdi cac thdng sd khac tren sieu am va tren thdng tim. Dd'i tugng va phuang phdp nghien cdu: sieu am Doppler tim ddac thdc hien tren 30 ngddi binh thddng va 50 benh nhan HIIL kbit . Sd dung chi sd Tei that phai (do tren phd sieu am Doppler qua van Ba la va van DMP) de danh gia chdc nang toan bo that phai. Ket qua va Ke't luan: d benh nhan HHL kbit, chi sd Tei that phai cao han ro ret so vdi ngudi binh thddng (0,47 ± 0,02 so vdi 0,19 ± 0,04, p = 0,007); Chi sd Tei that phai cd tddng quan chat che vdi ap ldc tam thu that phai (r = 0,8 ; p < 0,001), vdi ap ldc tam thu, ap ldc tam trddng, ap ldc trung binh DMP (vdi r lan Idat la 0,61; 0,47; 0,46 va p < 0,001). Chi sd Tei tdang quan yeu vdi dien tich Id van hai la (r = - 0, 33; p = (),ni).
Tu khoa: hop hai la khi't (HHL), Chi so Toi that phai, chdc nang that phai
36
I. DAT VAN DE
Hep van hai Id (HHL) la benh tim m i c phai cdn gap kha pho bien d Viet Nam. Hep van hai la d mdc dp nhe va vda it cd anh hddng de'n huye't dpng, benh nhan van cd the sinh hoat ddde binh thddng, nhdng khi hep hai la kbit se gay hau q u i nghiem trpng de'n huye't ddng ma hau q u i cudi eung la suy tim phai. Cac nghien edu deu cho tha'y trong HHL chdc nang that phai la ye'u td' quan trpng ed anh hddng nhieu tdi cae trieu chdng lam sang, kha nang gang sdc cua benh nhan cung nhd kha nang sdng sdt cua benh nhan trddc va sau phau thuat hoac can thiep van.
Cd n h i l u phddng phdp da ddoc dng dung de danh gia chdc nang that phai nhd: tam thanh cd dpng do, tham dd phdng xa, thdng tim chup budng tim, sieu am tim. Sieu dm tim la phddng phap tham dd khdng chay mdu, cung cap n h i l u thdng so' cd gia trj va de thdc hien. Tuy nhien ddnh gia phan so' td'ng mau (EF) cua that phai tren sieu am 2D gap n h i l u han che do ca'u true cua that phai. Nam 1996 Tei.C da dUa ra chi so' chdc nang cd tim (MPI), cdn gpi la chi so Tei de ddnh gia chdc nang that trdi va de'n nam 2000 da ddde dng dung de danh gid chdc nang that phai 17]. Cae nghien cdu da cho tha'y day la mdt thdng so' cd gia tri de danh gid chdc nang toan bq tha't phai.
Ci Viet Nam, ehda cd nghien cdu nao dng dung chi so Tei de ddnh gid chdc nang that phai d benh nhdn hep hai Id kbit. Vi vay nghien cdu ddde thdc hien nham muc tieu:
Ddnh gia chdc nang that phai bang chi so Tei d benh nhan hep hai la kbit va phan tich moi lien quan gida chi so' Tei vdi mgt so thdng so khac.
II. DOI TUONG vA PHUONG
P H A PNGHIEN CL/U
1. Doi tuong nghien cu'u
Dd'i tddng nghien cdu cua chung tdi dUdc chia lam 2 nhdm.
Nhdm 1 (nhdm chdng): gom 30 ngddi khoe manh (khdng cd cae trieu chdng lam sang cua benh tim mach; dien tam do, XQ tim phd'i, sieu am - Doppler tim binh thddng), tddng dddng v l dp tud'i va gidi dd'i vdi nhdm benh.
Nhdm 2 (nhdm benh): gom 50 benh nhan, ddde ehan doan la HHL kbit da ddde hpi ehan tai Vien Tim Mach, Benh vien Bach Mai, cd chi djnh nong van hai la. Khdng Ida chpn cac benh nhan cd: rung nhi, HoHL, HoC > 2/4, Hd van ba Id thdc td'n, cd benh phd'i, benh he thd'ng kem theo.
2. Phu'dng phap nghien cu'u
2.1. Thiet ke nghien cdu: md ta, e l t ngang va theo ddi dpc.
2.2. Cac budc tien hanh
Kham lam sang: hdi benh va kham lam sang tl ini, lam mdt sd' tham dd c i n thie't (DTD 12 chuyen dao; XQ tim phd'i; Xet nghiem mdu). Sieu am - Doppler t i m . Xac djnh chan doan la HHL kbit.
Lam benh an theo mau nghien cdu rieng.
Lam sieu am tim theo yeu cau cua nghien edu:
trdde nong van hai la td 24 - 48 gid. Cd m i u sieu am nghien edu rieng.
Tat c l cac benh nhan ddde thdng tim va nong van hai la bang bdng tai phdng tham dd huye't dpng Vien Tim maeh. Cd phieu thdng tim va nong VHL rieng.
2.3. Phuang phap tie'n hanh sieu am - Doppler tim
Dja diem: phdng sieu am tim, Vien Tim Mach, Benh vien Bcich Mai.
Phddng tien: may sieu am Doppler mdu ALOKA. Mdy cd 2 dau dd: 2,5 va 5 MHz cd nhieu chdc nang, cd the tham dd cde kieu sieu am T M , 2D, Doppler (xung, lien tue, man). May cd sdn chddng trinh vi tinh gidp chd do dae vd tinh todn ket qua.
Cac thong so Sieu am - Doppler khao sat
trong nghien ciJu:
Cac thdng so vi kich thudc va chdc nang that phai:
Sieu am T M : - Dddng kinh that phai Sieu am Doppler:
Thdi gian tien td'ng mau that phai (TG TTMTP);
Thdi gian td'ng mau that p h l i (TG TMTP);
Thdi gian gian dong the tich that phai (TGGDTT).
Thdi gian co dong the tich Ihci't ph.ii (TGCDTT):
Td dd tinh ra: ehi so' td'ng mau that phai (TMTP) = TG TTMTPAFG TMTP;
Chi so Tei that p h l i : chi so MPI ( chi so chClc nang that phai).
MPI =
a - b (ICT + iRT)ECG
Hinh 1. Minh hoa do cdc thdng sd tren sieu am Doppler
a: thdi khoang ddng md van ba la; b: thdi gian tdng mau that phai (ET); e: thdi gian tien td'ng mau that phai (PIP) c: QRS - md van ba la; d: QRS - ddng van DMP.
* Dien tich Id van hai la: do theo phddng phdp Fl/2 cua Hatle tren phd' Doppler qua van hai la va do trdc tiep tren sieu am 2D.
• Ap ldc tam thu DMP: ddc tinh qua phd' Doppler eua hd van ba la hoac pho Doppler eua l)(') \an DMP.
* Chenh ap qua van hai la.
2.4. Cdc thdng so do tren thdng tim: dp lUc N f Imng L:)inh, cudi tdm thu, cuoi tam trddng; dp life E)MP trung binh, cudi lam thu, ciid'i tam Inrong; dp ldc that phai trung binh, cuoi tam thu, (ii()i I d m I r d d n g .
3. Xu' ly thong ke so lieu nghien ciJu
Cae so' lieu thu thap ddde xir ly thed thuat tuan thd'ng ke y hpc bdng phan mem SPSS 11.5 va Epi - Info 6.04 cua To' chdc Y te The gidi.
III. KET QUA
1 . Dae diem cac doi tddng nghien cdu
1.1. Dae diem ve tudi va gidi cua nhdm HHL kbit va nhdm chdng.
Trong thdi gian td thdng 12/2004 de'n ihdng 10/2005. Chung tdi tien hdnh nghien cdu tren 30 ngddi khoe manh, 50 lienh nhan FIFII kbit.
38
Nhdm HHL kbit cd tud'i trung binh la 39,3±
11,6 tud'i, nam /nd = 10 (20%)/40 (80%); Nhdm chdng ed tud'i trung binh la 35,23 ± 7,6 tud'i, nam /nd = 6 (20%)/ 24 (80%); Khdng ed sd khac biet giira nhdm benh vd nhdm chdng v l tud'i vd gidi (p > 0 , 0 5 ) .
1.2. Dae diem ciia nhdm HHL kbit (n = 50) Tan sd tim trung binh ctia cac benh nhan nghien cdu la 81,22 1 10,91 (chu ky/ phut), HA Tam thu 99,2 + 8,35 (mmHg), H.A Tam trdang la 61,2 + 3,2 (mmHg). 42 bn (84%) mdc do suy tim NYHA II, 8 bn (16%) cd NYHA do III.
Bangl.
Thong so
Dddng kinh nhT trai (mm) Dudng kinh DMC (mm) Da (mm)
Di (mm) V,|(ml) V, (ml) D (%) EF (%)
TSTT tam thu (mm) TSTT tam trUdng (mm) VLT tam thu (mm) VLT tam trdong (mm) EXidng kinh that phai (mm)
Ke't qud sieu am TM vd 2D d nhdm HHL
Nhom H H L ( n = 50) 41,82 ± 4 , 1 6 25,58 ± 3,97 43,62 ± 5,43 29,02 ± 4 , 8 0 87,42 ± 22,47 33,56 ± 12,39 33,22 ± 6,17
61,8 ± 8,4 11,10 ± 1,31
6,24 ±1,04 8,68 ±1,68 6,02 ± 1 , 1 8
21,2 ± 2,9
Nh
so vdi nhdm chdng
6m ehu'ng (n = 30) 29,93 ±1,55 29,13 ± 1,87 45,87 ± 2,76 28,30 ± 3,2 9 7 , 1 0 ± 13,71
30,63 ± 8,28 38,10 ± 4 , 5 8 68,03 ± 0,09 10,4 ± 1,40 6,13 ± 1,07 8,6 ± 1,5 5,87 ± 1,07 2 0 , 5 0 ± 1,19
P p = 0,0000 p = 0,0000 p = 0,0382 p = 0,47 p = 0,0363 p = 0,2541 p = 0,0003 p = 0,0001 p = 0,66 p = 0,03 p = 0,8 p = 0,56 p = 0,2123 Nhdm benh nhan HHL kbit cd dddng kinh nhi trai, dddng kinh that phai Idn ban so vdi nhom chdng (p < 0,05); Dddng kinh that trai, the tich that trai, phan so td'ng mau ET nhd ban so vdi nhdm chdng (khac biet cd y nghia, p < 0,05).
2. Ket qua sieu am Doppler tim ve chu'c nang that phai d nhom benh so vdi nhom chiirng va cac ye'u to lien quan.
2.1. Cac thdng so sieu am Doppler that phai d nhdm HHL kbit va nhdm chdng
"• • •• Bang 2. Cac thdng sd sieu am Doppler thai phai d nhdm benh (HEIL kbit) va nhdm chdng Thong so sieu am
Thdi gian tien tong mau (ms) Thdi gian td'ng mdu (ms) Thdi gian eo dong the tich (ms) Thdi gian gian ddng the tich (ms) Chi sd Tei TP (ms)
Cbt so tdng mau that phai (ms)
Nhom HHL kbit (n = 95,04 ± 16,01 273,28 ± 34,87
38,56 ± 29,53 86,16 ± 47,66 0,47 + 0,02 0,35 ± 0,04
50) Nhom ehu'ng (n = 30) 76,80 ± 5,55 315,17 ± 22,99
23,07 ± 5,55 36,67 ± 10,14
0,19 ± 0,04 0,23 ± 0 , 0 3
P
= 0,0000
= 0,0000
= 0,0058
= 0,0000
= 0,0000
= 0,0000
Nhd vay d cae benh nhan HHL kbit cd cae thay doi nhd sau:
- Keo dai thdi gian tien td'ng mau (95,04 ± 16,01 ms) so vdi nhdm chdng (76,80 ± 5,55 ms), vdi p < 0 , 0 1 .
- Keo dai hdn thdi gian eo dong the tich (38,56 ± 29,53 ms) so vdi nhdm chdng (23,07 + 5,55 ms) va thdi gian gian dong the tich (86,16 ± 47,66 ms) so vdi nhdm chdng (36,67 ± 10,14 ms) vdi p < 0,01.
Ngdde lai, thdi gian td'ng mau that phai thi ngan hdn (273,28 ± 34,87 ms) so vdi nhdm chdng (31 5,1 7 ± 22,99 ms) vdi p < 0 , 0 1 .
Chi so Tei that phai tang hdn (0,47 ± 0,02) sd vdi nhdm chdng (0,19 ± 0,04), sd khac biet ed y nghTa thong ke vdi p < 0 , 0 0 1 .
2.2. Anh hudng cua tan so' tim va tuoi dd'i vdi cac thdng so' that phai d benh nhan HHL khit:
O nhdm benh nhan HHL khit: khong tha'y cd md'i tddng quan gida c l e thdng sd' that phai vdi tan so' tim (p > 0,05). Chi so' Tei tddng quan rat yeu vdi t i n so' tim (p = 0,03; r = 0,29) va khdng tddng quan vdi tud'i (p = 0,076; r = - 0,25).
2.3. Lien quan gida chi so' Tei that phai vdi cac thdng sd that phai d benh nhan HHL khit:
Chi so' Tei tddng quan vdi ta't ca eae thdng so':
thdi gian tien td'ng mau (r = 0,5), thdi gian td'ng mau (r = - 0,7), thdi gian co dong the tich (r = 0,5), nhdng chat ehe nha't vdi thdi gian gian dong the tich (r = 0,79) vdi p < 0,0001
2.4. Tuang quan gida chi so Tei that phai vdi cac thdng so khac tren lam sang, sieu am va thdng tim d benh nhan HHL khit
* Md'i tddng quan gida "chi sd'Tei that phai vdi mdc dp NYHA.
Nghien cdu tddng quan gida ehi so' Tei tha't p h l i va mde dp NYHA (la da'u hieu danh gia suy that phai tren lam sang), ke't qua cho tha'y chi so Tei T.P d nhdm benh nhan NYHA 111 (0,68 ± 0,20)
eao hdn rd ret so vdi nhdm N Y H A II (0,43 + 0,22) khac biet ed y nghTa vdi p = 0,004.
* Md'i tddng quan gida ehi so' Tei that phai vdi mpt so' thdng so' sieu am Doppler tim (n = 50).
Chi so Tei T.P tddng quan chat ehe nha't vdi ap ldc DMP tam thu (r = 0,62; p = 0,01), tddng quan ye'u vdi dien tich van hai la (- 0,33; p = 0,01) va chenh ap toi da qua van (r = 0,42; p = 0,01) va tddng quan rat yeu vdi DK that phai (r = 0,26; p = 0,05).
* Moi tddng quan giCfa ehi so' Tei that phai va eae thdng so' do tren thdng tim:
Trong so' 50 benh nhan nghien edu, ta't e l 50 benh nhan deu ddde danh gia ap ldc DMP tren thdng tim, ed 20 benh nhan ddde do ap ldc buong that phai, ke't qua eho tha'y ehi so' Tei tddng quan chat ehe vdi ap life that phai tam thu (r = 0,8, p = 0,0001) va ap ldc DMP tam thu (r = 0,61, p = 0,0001); Chi so' Tei ed tddng quan vda vdi ap ldc that p h l i trung binh (r = 0,57; p = 0,008) va ap ldc DMP trung binh (r = 0,46; p = 0,001) va ap ldc DMP eudi tam trddng (r = 0,4; p = 0,001).
Khdng ed tddng quan gida chi so' Tei T.P vdi ap ldc that phai cuoi tam trddng (r = 0,025, p = 0,025).
IV. B A N L U A N
1. Chufc nang that phai d benh nhan HHL khit
Cho den nay c l e nghien cdu deu eho tha'y rd la so vdi chdc nang that trai, chdc nang that phai bao gom e l tinh trang t u i n hoan phoi la yeu to' quan trpng hdn ed anh hddng de'n eae trieu chdng lam sang, kha nang gang sdc eung nhd kha nang song cdn eua benh nhan HHL kiiit.
HHL vdi hau qua la tang ap lue mad mach phdi bit, tang ap ldc dpng maeh phd'i trung binh, tang hau gdnh tha't phai se d i n tdi giam phan so td'ng mdu that p h l i .
Da cd n h i l u nghien cdu v l chdc nang that phai d eae benh nhan HHL khit. Phan sd tdng
40
mail thirdng ddng de ddnh gia chdc nang that phai, nhdng nd bj phu thuoe vao hau ganh va t i l n gdnh, mat khac bj anh hddng tdong tac cua chdc nang tha't trdi. Chdc nang that trdi g i i m se anh hddng de'n chdc nang that phai do vira lam tang hau ganh vCra gay ra sd I n h hudng tddng hd gida hai that.
Phan so td'ng mdu ed the danh gia b i n g phddng phdp chup can quang buong tam that, xa hinh buong tdm that, chup cpng hudng tCr, sieu am tim 2D. Tuy nhien do ca'u true phde tap cua tam that phai nen ed n h i l u khd khan trong viec danh gia chdc nang that p h l i b i n g cdc phddng phap chan ddan hinh anh nay.
Nam 2000 Tei.C [7] da dng dung ehi sc' ehdc nang cd tim (MPI) tinh b i n g "td'ng thdi gian gian dong the tich va thdi gian co ddng the tich chia cho thdi gian td'ng mau that phdi" (edn ddoc goi la chi so Tei) de danh gia chdc nang thd't phai d cac benh nhan tang dp ldc ddng mach phd'i tien phdt (day la cdc benh nhdn cd suy g i i m dong thdi ca ehdc nang tain thu vd chdc nang tam trdong). Ket qua eho tha'y d cac benh nhan nay cd tinh trang keo dai thdi gian co dong the tich va thdi gian gian dong the tich (85 ± 41 ms vd 1 35 + 43 ms so vdi nhdm chdng la 38 1 7 ms vd 49 + 9 ms, vdi p < 0,01). Thdi gian td'ng mdu co n g l n Icji la 241 i_ 43 ms so vdi nhdm chdng 332 t 21 ms vdi p < 0,01. Chi Sd Tei that p h l i la 0,93 ± 0,34 so vdi nhdm chdng la 0,28 + 0,04. Ke't qua nghien cdu cung khang djnh day la thdng so ed y nghTa quan trpng dd'i vdi cac da'u hieu lam sang va trong tien lUdng thdi gian sd'ng cdn cua cdc benh nhdn nay. Trong nghien cdu nay tdc gia eho tha'y Chi so Tei that phai khdng bj anh hddng bdi t i n so tim, khdng lien quan vdi dp ldc that phai, dp gian thci't phai hay mdc dp hd van ba Id.
Nghien cdu ddc diem chdc nang that phai d benh nhan hep hai la khit chdng tdi tha'y thdi gian gidn dong the tich vd thdi gian co dong the
tich keo dai hdn so vdi nhdm chdng (86,16 + 47,66 ms so vdi 36,67±10,14 ms vdi p < 0,001 va 38,56 ± 29,53 ms so vdi 23,07 1 5,55 ms vdi p <
0,001). Thdi gian td'ng mdu that phai n g l n hon rd ret Sd vdi nhdm chdng (273,28 + 34,87 ms so vdi 31 5,1 7 + 22,99 ms vdi p < 0,001). Chi so Tei that phai d benh nhan hep hai la khit ldn hdn rd ret so vdi nhdm chdng (0,47±0,02 so vdi 0,19 ±0,04 vdi p < 0,001).
Nghien cdu cua Jagdish [4] ve chdc nang that p h l i tren 25 benh nhan HHL khit eung eho tha'y:
thdi gian eo ddng the tich va thdi gian gian dong the tich keo dai hon so vdi nhdm chdng (104 + 37 ms so vdi 49 ± 18 ms, p < 0,0001 va 106 ± 42 ms so vdi 52 ± 15 ms, p < 0,001); thdi gian td'ng mau that phai co n g l n lai rd ret (285 + 96 ms so vdi 314
± 1 3 ms, p < 0,008). Chi so Tei, eung nhd chi so td'ng mau that phai tang len rd ret d cac benh nhan hep hai la nay (0,70 ± 0,25 so vdi chdng 0,32 ± 0,09 va 0,44 ± 0,1 3 so vdi 0,30 + 0,06, p < 0,001).
2.2. Cac ye'u to anh hudng den thdng sd chdc nang that phai
Cung nhd nghien cdu eua Tei, ke't q u i nghien cdu cua chdng tdi cho tha'y d nhdm hep hai la khit, chi so Tei khdng bi I n h hddng bdi t i n so tim va tud'i.
Mac dd chi so Tei ddde tinh dda tren 3 thdi k h o i n g : thdi gian eo dong the tich, thdi gian gian dong the tich, thdi gian td'ng mdu that phai, nhdng ehi sd Tei lien quan chat che nha't vdi thdi gian gian dong the tich (d nhdm chdng r = 0,86;
p < 0,0001; d nhdm hep hai la khit r = 0,795;
p < 0,0001).
Nghien edu tren nhdm HHL khit ehung tdi thay ehi so Tei thd't phcii ed lien quan Cci't chat vdi dp ldc tam thu that p h l i (r = 0,8; p < 0,0001), lien quan vCra vdi dp ldc trung binh that phai (r = 0,58;
p = 0,008) vd khdng tddng quan vdi dp lire cuoi tdm tnrong that phai (r = 0,025). Vdi dp ldc dpng
mach phd'j, ehi so Tei ed lien quan chat vdi dp ldc ddng mach phoi tam thu (r = 0 , 6 1 ; p < 0,001), tddng quan vda vdi dp ldc dpng mach phd'i tam trddng (r = 0,47, p < 0,001) va vdi ap ldc dpng maeh phd'i trung binh (r = 0,46; p < 0,001).
Nghien cdu eung eho tha'y cd md'i tddng quan ye'u gida chi so' Tei tha't phai vdi dien tfeh van hai Id va dddng kinh tha't p h l i do tren sieu am (r = - 0,33 vd r = 0,26).
Nghien edu eua Jagdish 14] edng cho ke't q u i tddng td: Chi sd' Tei cc tddng quan chat vdi dp ldc dpng maeh phd'i trung binh (r = 0,69; p = 0,006);
vdi thdi gian gian dong the tich (r = 0,76;
p < 0,0001) nhdng khcng cd tddng quan vdi dien tich van hai Id (r = - 0,32; p = 0,1) cung nhd t i n so tim (r = 0,21; p = 0,25).
Nghien cdu cua Burger W. (1997) 12] vc chdc nang that p h l i d benh nhan FIHL khit trdde va sau nong van bang phddng phdp pha loang nhiet cho thciy: d benh nhan FIHL khit phan so tdng mau that phdi giam 44 + 3% (binh thddng la 50 - 60 %), ehi sd' the tich td'ng mdu (SV index) giam va phan so' tdng mdu that phai tddng quan thuan vdi ehi so the tich td'ng mdu, tddng quan nghich vdi dp ldc trung binh dpng mach phd'i va sdc can dong mach phd'i.
Nghien cdu cdng eho tha'y dien tich van hai Id tUdng quan nghjeh vdi dp ldc dpng maeh phoi trung binh nhUng khdng tdong quan vdi phdn sc") td'ng mdu that phai va sdc c i n ddng mach phd'i.
Nghien cdu cua Grose R. [3] b i n g phddng phap chup buong that p h l i cdng cho ta tha'y phan sci' td'ng mau tha't p h l i ed lien quan chat che vdi dp ldc thd't phdi tam thu (r = - 0,67; p < 0,001) va dp ldc dgng maeh phd'i trung binh.
Seyfarth IT.] 16] nghien cdu tren 42 benh nhan tang dp ldc ddng mcich phoi tha'y chi sci' i e i cd tddng quan vdi phan so td'ng mdu thd't p h l i (RVEF%) do tren thdng tiin (r = 0,72; p < 0,001), vdi the tich tci'ng mdu thci't p h l i (r = 0,52;
|) < 0,001), vdi dp bdo hda oxy tinh mcich trung
tam (r = 0,58 ; p < 0,01). Nhdng khde vdi nghien edu cua chdng tdi va Jagdishl4] tren nhdm Ijenh HHL khit, nghien edu nay tren nhdm tang dp DMP eho tha'y khdng ed tddng quan gida chi so Tei that phai vdi dp ldc dpng mcich phd'i tmng binh va sdc can dpng mach phdi.
Thed Lutz J.T. 15] nghien edu tren thdc nghiem cho tha'y chi sci' Tei tha't phai bj I n h hddng bdi t i l n gdnh: khi lang dien tich nhT p h l i ( b i n g cdch tang Iddng djeh truyen vao nhT phai) thi chi so Tei thdt p h l i cung tang theo.
Benjamin nam 2000 da nghien edu chdc nang that p h l i d benh nhan tim bam sinh cho thay d eac benh nhan thdng licon nhT (la eac trddng hdp ed tang tien ganh) nhdm tre em ehi so' Tei thcit p h l i la 0,35 ± 0,09 (n = 45) khdng khac biet rd ret so vdi nhdm chdng (chi so Fci = 0,32 ± 0,03), cdn d nhdm ngddi ldn ehi sci'Tei that phdi la 0,38 + 0,4 (n = 40) cad hdn nhdm chdng (Tei = 0,28 ± 0,04) vdi p < 0 , 0 1 .
Chi so Fei that phai d benh nhan hep van dpng maeh pho'i (dai dien cho cdc trddng hdp cd tang hau gdnh) la 0,32 J 0,06 (n = 21) - khdng khde biet rd vdi nhdm chdng. Chi cd nhdm d l o goc ddng mach (nhdng trddng hdp cd hd van nhi that nhieu the hien sd tang e l T\e\\ gdnh vd hciii gdnh) chi so Tei that phdi la 0,72 1 0,17 (n ='27) va nhdm Ebstein (n = 24) cd chi sci Tei = 0,63 J 0,09 ed khac biet vdi nhdm chdng. Nghien cClii nay edn eho thay d e l nhdm thdng lien nhT va nhdm hep van dpng mach phd'i khdng cd sd thay dd'i ehi so Tei sau phau thuat (tdc la khi da cd c i i thien v l t i l n gdnh vd hau gdnh). I d ke't qua nay cdc tdc gia cho rang chi sd Fei ddnh gid chdc:
nang that p h l i ma khdng plui Ihudc vdo tien ganh va h l u gdnh. i i i y nhienn day Id mpi nghien cdu hoi cdu eac thdng so' do dae chi so sdnh trddc va sau p h l u thutit ma ehda theo ddi dgc lau ddi nc^n ehda ddnh gid ddde sd thay doi cua chi so lei lau dai sau phau thuat.
42
V . K E T L U A N
6 benh nhan HHL khit, Chi so' Tei that phai tang so vdi nhdm chdng (0,47 ± 0,24 vdi 0,19 ± 0,04). Chi so' Tei la thdng so' khong bi phu thupc vao tan so' tim va tud'i. Cdc ye'u to' lien quan den chi so' Tei tha't p h l i d benh nhan HHL khit la ap ldc that phai (r = 0,8; p = 0,001 ), dp ldc DMP (r = 0 , 6 1 ; p = 0,001), Chenh dp qua VHL (r = 0,425), dp NYHA (r = 0,47). Dien tich VHL, dp lUc eudi tam trddng tha't phai it I n h hddng de'n ehi so Tei (r = - 0 , 0 3 ; r = 0,025).
Chi so' Tei that phai do tren sieu am Doppler tim la thdng sd' ddn g i a n , tin cay de ddnh gid ve chdc nang that phai d benh nhan hep hai Id khit.
T A I LIEU T H A M
KHAO
1. Benjamin W.E, Patrick W.O, Tei C and lames B (2000), "Usefulness of the myocardial performance index for assessing right ventricular function in congenital heart disease". Am j . Cardiol, 86: pp. 6 5 4 - 6 5 8 .
2. Burger W., Brinkics C. et. al. (1997), "Right ventricular function before and after percutaneous balloon mitral valvuloplasty", Int J. Cardiol, 58:
pp. 7 - 1 5 .
3. Grose R., Strain J., Vipintosoi T. (1983),
"Right ventricular function in valvular heart disease: relation to pulmunary artery pressure", J.
Am. Cardidl 2: pp. 225 - 32. •
4. jagdish C M , Sengupta P.P and Ramesh A.
(1997), "Immediate and delayed effects df successful percutaneous transvenous mitral commissurotdiny on global right ventricular function in patients with isdlated mitral stenosis".
Cardiology, 58: pp. 21 7 - 223.
5. Lutz J.T, Giebler R., Peters J. (2005), "The
"Tei - index" is preload dependent and can be measured by transoesophageal echocardiography during m e c h a n i c a l v e n t r i l a t i o n " , Eur j . Anaesthesiol, 22: pp. 1 54 - 5.
6. Seyfarth H.J, Pankau H., Qinkler J. (2004),
"Correlation of Tei index and invasive parameters of right heart function in PAH", Pneuinology, 58:
pp. 2 1 7 - 2 1 .
7. Tei C , Dujardin K.S, Hodge D.O et al.
(2000), "Doppler echocardiographie index for assessment of global right ventricular function", j . Am Soe Echocardiography, 1 3: pp. 882 - 3. ' Summary
RIGHT VENTRICULAR FUNCTION IN PATIENTS WITH MITRAL STENOSIS
Objective: to investigate the right ventricular (RV) Tei index in patients (pts) with mitral stenosis (MS) and to assess the correlation with the other parametres (RV Pressure, pulmonary artery pressure (PAP), valve orfice areares...). Methods: RV Tei index was assessed in 50 pts with MS before PTMC and 30 healthy subjects. Tei index was determined by pulsed wave Doppler in tricuspid valve inflow and pulmonary valve outflow. Results and conclusion: in MS pts, RV Tei index was significantly greater than in the healthy subjects (0.47 ± 0.02 vs 0.19 ± 0.04, p = 0.001). A good correlation existed between the RV Tei index and the systolic RV pressure, systolic, diastolic, mean pulmonary pressure (r = 0.8; 0 . 6 1 ; 0.47;
0.46, p < 0.001). There were moderate correlation between the RV Tei index and mitral valve orifice areas (r = - 0.33; p = 0.01).
Key words: RV Tei index, right ventricular function, mitral stenosis
