Assessment Of Right Ventricular And Left Ventricular Function In Patients With Chronic Obstructive Pulmonary Disease Using Tissue Doppler Tei Index

Objective:Tissue Doppler(DTI)Tei Index and Related Parameters to Assess Right Ventricular and Left Ventricular Function in Patients with Chronic Obstructive Pulmonary Disease(COPD)and Explore the 2017 Global Strategy for Diagnosis,Treatment and Prevention of Chronic Obstructive Pulmonary Disease(GOLD)The new structure of COPD patients in different degrees of severity of the right ventricle and left ventricle of secondary structural and functional changes,dedicated to the clinical evaluation of COPD patients with cardiac function to provide effective echocardiographic indicators and reliable basis.Materials and Methods:From December 2016 to November 2017,a large number of outpatients and hospitalized patients with a diagnosis of COPD were screened.123 patients with stable COPD were selected as the observation group,including 94 males and 29 females.58.9 ± 7.28 years old,according to the 2017 version of the comprehensive evaluation criteria in GOLD,123 patients were divided into A.B.C.D four groups;the other at the same time selected in our physical examination center physical examination,to exclude the impact of heart and lung disease and the recent history of no respiratory infection Among the 30 patients with middle-aged and older physical examinations as the control group,23 were males and 7 were females with an average age of 57.6±6.28 years.All selected patients were informed informed consent and the relevant data was collected within 24 hours.The United States GE company ViViD-E9 heart color Doppler ultrasound diagnostic instrument,model for the M5S-D two-dimensional heart probe,the probe frequency of 2-5MHz,synchronized lead electrocardiogram.The patient underwent decubitus position on the left side and breathed calmly.After the patient was subjected to routine cardiac ultrasound imaging,relevant indicators needed for the study were obtained in the following manner:1)Routine cardiac ultrasound measurement:The parasternal left ventricle long-axis view M-sampling line is placed at the level of the mitral valve chordae,perpendicular to the interventricular septum and the posterior wall of the left ventricle,and measured at the end-diastolic thickness.),right ventricular anteroposterior diameter(RV),interventricular septal thickness(IVS),left ventricular end-diastolic diameter(LVEDd),left ventricular posterior wall thickness(LVPW),and left ventricular ejection fraction obtained by the instrument with a calibrated cubic volume method(EF);the same aspect at the end of systole measuring the posterior wall of the aorta to the posterior wall of the left atrium,obtaining the anteroposterior diameter(LA)of the left atrium;mobile ultrasound probe showing the short axis of the parasternal aorta,making the aorta round in the middle of the image At the end of diastole,the diameter of the main pulmonary artery(MPA)was measured at a distance of 1 cm distal to the pulmonary valve annulus;the right atrium diameter(RA)was measured with a standard four-chamber view.2)Tissue Doppler-related index acquisition method:Tissue Doppler imaging mode(DTI)was started at the standard apical 4-chamber view,and the sampling volume was placed at the attachment of the anterior tri-valvular annulus to the right ventricular lateral wall to obtain three tips.The cardiac motion spectrum of the annulus measures the early diastolic Ea peak,late diastolic Aa peak,systolic Sa peak,right ventricular isovolumic contraction time(R-IVCT),isovolumetric diastolic time(R-IVRT),and ejection time(R-ET);In the same mode,the sampling volume is to the left ventricular lateral wall mitral valve annulus attachment to obtain the mitral annulus myocardial motion spectrum,measured early diastolic e peak,late diastolic a peak,systolic s peak Left ventricular isovolumetric contraction time(L-IVCT),isovolumic relaxation time(L-IVRT),and ejection time(L-ET).The above data were recorded continuously for three cardiac cycles,and the mean value was calculated and recorded in the case report form.3)The calculation method of Tei and other related indicators:Tei?IVRT+IVCT/ET;Tei-1=IVRT/ET;Tei-2=IVCT/ET.Results:1.Comparison of basic data:1)There was no significant difference in gender composition ratio,age,height,and weight between the control group and the COPD group(P>0.05);2)Heart rate of the COPD group was faster than that of the control group.However,there was no significant difference between the A group and the control group(P>0.05);The comparison between the two groups in the COPD group was significantly higher in the D group,which was significantly different from the other three groups(P<0.01).2.Comparison of general parameters of the right heart:I)Thickening of the right ventricle anterior wall(RVAW)in the COPD group,broadening of the pulmonary artery trunk diameter(MPA):the thickness of the anterior wall of the right ventricle is at an average of more than 5 mm,and the intragroup increases progressively.After one-way analysis of variance,there was a statistical difference between groups(P<0.05);within the COPD group,statistical differences of MPA existed only in some groups;2)The interval thickness(IVS),right anteroposterior diameter(RV)and right atrial transverse diameter(RA)of COPD in each group were increased compared with the control group,while in group D,but only between the groups and within the group.There are statistical differences.3.Comparison of left ventricular general parameters:1)In COPD group,the left ventricular end-diastolic dimension(LVEDd)was decreased,and left ventricular posterior wall(LVPW)was thickened.Compared with the control group,only group A was not statistically significant(P>0.05);2)There was no significant difference in left anterior anteroposterior(LA)between COPD group and control group(P>0.05);3)Left ventricular ejection fraction(EF)decreased significantly in group D patients with COPD,but remained within the normal range.4.Doppler parameters of the right ventricle were compared:1)Compared with the control group,the Ea,Ea/Aa of the right ventricle in the COPD group were significantly different(P<0.05).There was a statistical difference in the COPD group only in some groups;2)The statistical differences of Aa and Sa in COPD group were later than those of Ea and Ea/Aa.5.Doppler parameters of left ventricular tissue were compared:1)The left ventricle e and e/a in the COPD group showed a decreasing trend,and the reference group was the reference.Only the C and D groups had statistical differences(P<0.05);2)Using the reference group as a reference,statistical differences in left ventricle a and s only occurred in COPD patients in group D(P<0.05).6.Right ventricular TDI-Tei and other related parameters were compared:1)COPD group right ventricle IVRT,Tei-1,Tei is greater than the control group,in which the Tei index increased in turn,one-way analysis of variance,each group had significant statistical differences(P<0.01);2)With reference to the control group,IVCT,Tei-2,and ET in the right ventricle of the COPD group were gradually graded.Statistical analysis showed that there was no significant difference between the A group and the control group(P>0.05).Differences between the groups and within the group were statistically significant(P<0.05).7.Comparison of left ventricular TDI-Tei and other relevant parameters:COPD left ventricular ET decreased in turn,IVRT,IVCT,Tei-1,Tei-2,and Tei increased in turn,ET decreased,D group was the most significant,the above indicators in A group and There was no significant difference between the control groups(P>0.05).The Tei difference was most significant after the comprehensive analysis.Except for the A group and the control group,there was a significant difference between the other groups(P<0.05).8.Analysis of correlation between left and right ventricle Tei index and basic data of patients:There was no correlation between left and right ventricle Tei index and heart rate,age,height,and weight in COPD groups and control groups.9.Analysis of correlation between left and right ventricle Tei index and conventional indicators:1)There was a significant negative correlation between the right ventricle Tei and right ventricle Ea/Aa,Sa,left ventricle Tei and left ventricle e/a,EF,and LVEDd.(r?-0.561,p<0.001;r?-0.663,p<0.001;r=-0.394,P<0.001;r=-0.277;p<0:001;r=-0.460,p<0.001);2)Right ventricle Tei There was a significant positive correlation between index and RVAW,IVS,RV,RA,MPA,left ventricle Tei index and LVPW(r?0.701,p<0.001;r=0.662,p<0.001;r=0.495,p<0.001;r=0.491,p<0.001;r=0.612,p<0.001;r=0.305,p<0.001);3)Tei index of the left ventricle was not correlated with mitral annulus s,LA(r=-0.069,p=0.394;r=0.042,p=0.605).10.Left and right heart function correlation analysis:1)Right ventricle Ea/Aa and left ventricle e/a,right ventricle tricuspid ring Sa peak and left ventricle EF,right ventricle Tei and left ventricle Tei were significantly positively correlated Sex(r=0.229,p<0.01;r?0.354,p<0.001;r?0.726,p<0.001);2)There was no correlation between the right ventricle tricuspid ring Sa peak and left ventricular mitral annulus s peak(r?0.079,p?0.333).Conclusions:1.The most sensitive structural change in patients with COPD is the thickening of the anterior wall of the right ventricle,and the left cardiac structural changes appear later.The main manifestations are the reduction of the left ventricular end-diastolic diameter and the thickening of the posterior wall of the left ventricle.2.The early right diastolic function of patients with COPD was reduced,and the left and right cardiac diastolic function was impaired.Left ventricular and right ventricular systolic dysfunction occurred later than diastolic function.3.The overall function of right ventricle in patients with COPD was impaired and showed progressive development.The overall function of the left ventricle was also impaired in the middle and late stages,with diastolic function as the main function.4.There is a significant positive correlation between left and right heart and heart function.5.The Tei index has significant correlation with routine cardiac function indexes,and has good correlation with the COPD comprehensive assessment group.It can be used as an efficient indicator for the assessment of the overall function of the right ventricle and left ventricle.