Clinical usefulness of carotid arterial wave intensity in assessing left ventricular systolic and early diastolic performance
Clinical usefulness of carotid arterial wave intensity in assessing left ventricular systolic and early diastolic performance
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DOI：
10.1007/s00380-003-0700-5
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发表时间：
2003-07-01
影响因子：
1.5
通讯作者：
Kimura, G
中科院分区：
文献类型：
--
作者：
Ohte, N;Narita, H;Kimura, G
波强度(Wi)是一种新的血流动力学指标，定义为(dp/dt).(Du/dt)，其中dp/dt和du/dt分别是血压和血流速度对时间的导数。然而，这一指标在临床上的病理生理学意义尚未完全阐明。因此，我们在患者中调查了这一问题，这些患者接受了有创的左心功能评估。使用彩色多普勒血流速度测量系统结合回声跟踪法检测血管内径变化，获得右侧颈动脉的Wi。血管直径变化通过收缩压和舒张压校准其峰值和最小值，自动转换为压力波形。患者的MRI表现为两个锐利的正峰。第一个峰值出现在LV射血的早期，第二个峰值出现在射血末期。第一峰的大小与左心室压力最大上升速率(LVmax)显著相关。Dp/dt)(r=0.74P<；0.001)。WI第二峰波幅与LV松弛时间常数显著相关(r=-0.77P<；0.001)。收缩晚期动脉血流惯性力组第二峰波幅明显大于无惯性力组(3080±1741vs1890+/-1291 mm Hg M S(-3)，p<；0.01)。这些结果表明，第一峰的幅度反映了左室收缩性能，而第二峰的幅度由收缩晚期至等容舒张期的左心室行为所决定。Wi是一种无创性获得的、临床上有用的参数，可同时评估LV的收缩和早期舒张期功能。
Wave intensity (WI) is a novel hemodynamic index, which is defined as (dP/dt).(dU/dt) at any site of the circulation, where dP/dt and dU/dt are the derivatives of blood pressure and velocity with respect to time, respectively. However, the pathophysiological meanings of this index have not been fully elucidated in the clinical setting. Accordingly, we investigated this issue in 64 patients who underwent invasive evaluation of left ventricular (LV) function. WI was obtained at the right carotid artery using a color Doppler system for blood velocity measurement combined with an echo-tracking method for detecting vessel diameter changes. The vessel diameter changes were automatically converted to pressure waveforms by calibrating its peak and minimum values by systolic and diastolic brachial blood pressures. The WI of the patients showed two sharp positive peaks. The first peak was found at the very early phase of LV ejection, while the second peak was observed near end-ejection. The magnitude of the first peak of WI significantly correlated with the maximum rate of LV pressure rise (LV max. dP/dt) (r = 0.74, P < 0.001). The amplitude of the second peak of WI significantly correlated with the time constant of LV relaxation (r = -0.77, P < 0.001). The amplitude of the second peak was significantly greater in patients with the inertia force of late systolic aortic flow than in those without the inertia force (3 080 +/- 1741 vs 1890 +/- 1291 mmHg M s(-3), p < 0.01). These findings demonstrate that the magnitude of the first peak of WI reflects LV contractile performance, and the amplitude of the second peak of WI is determined by LV behavior during the period from late systole to isovolumic relaxation. WI is a noninvasively obtained, clinically useful parameter for the evaluation of LV systolic and early diastolic performance at the same time.