摘要目的 探讨多普勒组织成像(TDI)参数二尖瓣E峰速度与二尖瓣环舒张早期峰值速度比值(E/Em)对急性心肌梗死(AMI)患者院内事件率的预测价值。方法 回顾性分析289例AMI患者临床资料、超声心动图。结果 及临床事件情况，根据F/Em结果分为两组：E/Em＜ 10组152例；E/Em≥10组137例；比较两组临床特点、超声心动图指标及院内事件率的差异。多因素Logistic回归分析住院期间发生心力衰竭的相关危险因素。结果 与E/Em＜ 10组患者相比，E/Em≥10组左心室舒张末内径[(52.3±7.3) mm比(49.2 ±5.2) mm，(P=0.000)]显著扩大；左心室射血分数[(48.3±11.7)％比(56.7±9.7)％，(P=0.000)]及舒张早期峰值速度Em[(6.4±1.9) cm/s比(9.4±2.4)cm/s，(P=0.000)]均显著降低。E/Em≥10组患者入院Killip分级[(1.7±0.9)比(1.2±0.6)，(P=0.000)]及住院心力衰竭（38. 5％比13.8％，P=0. 000）及死亡（4.4％比0.8％,P=0.000）发生率显著高于E/Em＜ 10组。E/Em升高、左心室射血分数降低是患者院内发生心力衰竭的独立危险因素。结论 心肌梗死早期E/Em可能是患者急性期发生左心室重构和心力衰竭有力的预测因素。

abstractsObjective To assess the prognostic values for in-hospital event rate of tissue Doppler imaging (TDI) parameter (E/Em) after acute myocardial infarction. Methods A total of 289 patients with acute myocardial infarction were retrospectively examined. Their clinical data and echocardiograms were obtained. Clinical events were recorded. Patients were divided into two groups according to the value of ratio of early transmitral flow velocity to early diastolic velocity of mitral annulus (E/Em) : Group E/Em ＜ 10 (n = 152) and Group E/Em≥10 (n = 137). Clinical characteristics, echocardiographic parameters and the rate of cardiac events were compared. Predictors of heart failure were identified by multivariate Logistic regression analysis. Results On echocardiography, the patients with an E/Em ratio ≥ 10 had statistically larger left atrial diameter [(39. 1 ±6. 2)vs (36. 0 ±4. 4) mm, P =0. 000]and left ventricular end diastolic diameter [(52. 3 ± 7.3) vs (49. 2 ± 5.2 ) mm, P = 0. 000]. Worse systolic functions were found in group E/Em ≥ 10: left ventricular ejection fraction (LVEF) [(48.3 ± 11.7 )％ vs (56. 7 ± 9. 7 )％, P = 0. 000].Systolic velocities of mitral annulus (Sm) [(6. 6 ± 1.7) vs (8.6 ±2. 2) cm/s, P =0. 000]. Em [(6.4 ± 1.9)vs (9. 4 ±2. 4) cm/s, P =0. 000]was statistically lower than that of E/Em ＜ 10 group. Killip classes on admission were statistically higher in group E/Em ≥ 10 than those of the other group [(1.7 ± 0. 9 )vs (1.2 ±0. 6), P =0. 000]. So were as the ratio of heart failure(38. 5％ vs 13. 8％, P = 0. 000) and inhospital mortality rate(4.4％ vs 0. 8％, P = 0.000). Logistic regression analysis demonstrated that the independent risk factors of heart failure included the value of E/Em and LVEF. Conclusion Early E/Em is probably a powerful predictor for left ventricular remodeling and in-hospital heart failure in patients after acute myocardial infarction.