| Objective:To assess the global cardiac function in different degrees of cirrhosis patients by mearsuing the left and right Tissue Doppler Tei(TDI-Tei)index,in order to provide quantitative clinical data for clinical understanding the cardiac status in patients with cirrhosis.Materials and methdods:Fifty-nine cirrhosis patients were selected as cirrhosis experimental group who diagnosed in department of gastroenterology,the first affiliated hospital of Nanchang university.The cirrhosis patients were divided into Child A,Child B,Child C groups according to the liver function Child-pugh grade.The Child A group include twenty-seven patients and Child B eighteen patients and Child C fourteen patients.Thirty subjects as normal control group who randomly accepted a healthy check at the same time in our hospital for cardiac color Doppler examination.The age,sex,and BMI of the subjects in the normal control group were required match to those of the cirrhosis experimental group.All subjects were chected after a five~ten minutes rest and breathe smoothly and heart rate steady.Asked all subjected take the left lateral position,simultaneous connection limb lead ECG.Transthoracic echocardiography in the two-dimensional or M-mode ultrasound in the left ventricular long axis of the heart,apical four-chamber view of the conventional measurements of cardiac related parameters,including left atrial anterior and posterior diameter(LAAPD),left ventricular end diastolic diameter(LVEDD),left ventricular end systolic diameter(LVESD),interventricular spetal dimension(IVSD),left ventricular posterior wall thickness(LVPWD),left ventricular ejection fraction(LVEF),right atrial up and down diameter(RAUDD),right atrial left and right diameter(RALRD),right ventricular end diastolic diameter(RVEDD).Switch to apical four-chamber view and open the Tissue Doppler model.The left and right ventricular TDI-Tei index was measured by dividing the pulse Doppler sampling volume into the ventricular wall with the mitral postrrior valve and the tricuspid anterior valve.The above data was statistical processed and further analyzed the correlation of the left and right ventricular TDI-Tei index with the Child-pugh grading.Using receiver operating characteritic(ROC)curve analysis the diagnosis efficiency of TDI-Tei index in judgment liver cirrhosis patients whether concurrent cardiac dysfunction or not.Result:1)Comparison of general information between cirrhosis experimental group and normal control group: there was no significant difference in age,sex and BMI between the cirrhosis experimental group and the normal control group(p>0.05).The heart rate of cirrhosis experimental group was higher than that of normal control group,the difference was statistically significant(p<0.05).2)Comparison of conventional ultrasound parameters between cirrhosis experimental group and normal control group: the LAAPD,LVEDD,IVSD,RAUDD,RALRD,RVEDD increased in cirrhosis experimental group compared with the normal control group,the difference was statistically significant(p<0.05).The LVESD,LVPWD,LVEF were not statistically significant in cirrhosis experimental group and normal control group(p>0.05).3)Comparison of the left and right ventricular TDI-Tei index between cirrhosis experimental group normal control group: the left and right ventricles TDI-Tei index in the cirrhosis experimental group were all significantly higher than that in the normal control group,the difference was statistically significant(p<0.05).4)Comparison of the left and right ventricular TDI-Tei index between cirrhosis of each group and normal control group.With the Child-pugh grade gradually increased,the degree of liver cirrhosis disease gradually increased,left and right ventricular TDI-Tei index also showed an increasing trend. The TDI-Tei index of left and right ventricle in Child A group was higher than that in normal control group,but the difference was not statistically significant(p>0.05), The TDI-Tei index of left ventricle in Child B group was significantly higher than that in normal control group(p<0.05),and there was no significant difference compared with Child A group(p>0.05).The TDI-Tei index of right ventricular was higher than the normal control group and Child A group,the difference was statistically significant(p<0.05), The TDI-Tei index of left ventricle in Child C group was higher than that in normal control group,Child A group and Child B group,the difference was statistically significant(p<0.05).The TDI-Tei index of right ventricle in Child C group was significantly higher than that in normal control group and Child A group(p<0.05),and there was no significant difference compared with Child B group(p>0.05).5)Correlation between left and right ventricular TDI-Tei index and liver function Child-pugh grade in cirrhosis group: there was a significant positive correlation between left and right ventricular TDI-Tei index and liver function Child-pugh grade.6)Respectively compared the left and right TDI-Tei index of the cirrhosis of each group and the normal control group suggested that,the left TDI-Tei index area under the curve was 0.837,the best node values was 0.395,the sensitivity was 80.0% and specificity was 78.6%,the right TDI-Tei index area under the curve was 0.755,the best node values was 0.380,the sensitivity was 63.3% and specificity was 78.6%.Conclusion:1)Cirrhosis can have a certain impact on the patient’s heart,the performance of the heart rate increased,the heart chamber structure increased.2)The TDI-Tei index of left and right ventricles in patients with liver cirrhosis all increased,suggesting the patient’s the left and right global function damaged.With the degree of liver cirrhosis gradually worsens,the left and right ventricular global function damage are become also more serious.3)The patient should be alert to cardiac global dysfunction when the left TDI-Tei index>0.395 or the right TDI-Tei index>0.380.4)TDI-Tei index can be objective,sensitive,comprehensive estimate global function of the heart.The operation is non-invasive,convenient.It is a good supplement to conventional echocardiography and worthy of popularization and application in clinic. |
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