Relation of left ventricular isovolumic relaxation time and incoordination to transmitral Doppler filling patterns
Relation of left ventricular isovolumic relaxation time and incoordination to transmitral Doppler filling patterns
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左心室等容舒张时间与二脉多普勒充盈模式不协调的关系
DOI：
10.1136/hrt.68.12.567
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发表时间：
1992
影响因子：
--
通讯作者：
D. Gibson
中科院分区：
文献类型：
--
作者：
S. Brecker;C. Lee;D. Gibson
目的：探讨左心室疾病患者等容松弛过程中决定多普勒充盈模式的因素，从而确定其潜在机制。设计：采用多普勒超声心动图和M型超声心动图对85例（缺血性心脏病50例，主动脉狭窄所致左心室肥厚35例）和26例对照进行研究。16例患者分别进行了两项研究，以确定等容松弛时间的变化是否反映在多普勒a /E比值的变化上。环境-三级心脏转诊中心。研究对象：评估冠状动脉疾病或主动脉狭窄伴左心室肥厚的患者。主要观察指标：舒张早期（E波）和晚期（A波）多普勒充盈速度及A/E比、E波加速度、非协调舒张的数字化M型指标（二尖瓣开启前腔尺寸变化和从最小尺寸到二尖瓣开启的时间）、等容舒张时间、二尖瓣开启后舒张功能的M型指标（后壁变薄峰值率和尺寸增加峰值率）、左心室舒张末期压。结果：正常受试者a /E与年龄相关（r = 0.74），左室肥厚受试者a /E与年龄相关程度较小（r = 0.41），缺血性心脏病患者a /E与年龄相关程度不显著。在所有患者中，等容舒张时间与E波加速度呈显著负相关，显示其与早期舒张充盈力的根本关系（左室肥厚r = - 0.71，缺血性心脏病r = - 0.74， p值< 0.01）。在左室肥厚和无左室扩张的缺血性患者中，A/E与等容舒张时间（r分别为0.68和0.60）和不协调舒张时间（r分别为0.65和0.61）相关。在伴有左室扩张的缺血性患者中，不协调的影响消失，等容松弛时间成为影响A/E的主要因素（r = 0.82）。考虑等容松弛时间后，舒张末期压和RR间期与A/E的弱相关性变得不显著。等容松弛时间和不协调共同占我们患者A/E比差异的50%以上。等容松弛时间与A/E比呈线性相关。等容舒张时间短的患者，尽管多普勒a /E正常，但仍有明显的舒张异常。在接受两次超声心动图检查的16例患者中，等容松弛持续时间的变化伴随着多普勒a /E比的变化。这两个变量之间的关系，从整个群体中得出是相似的。结论：影响左心室疾病患者A/E比值的主要因素是等容舒张的两种不同特性，即室壁不协调运动的持续时间和程度。填充压力和RR间隔不是显著的独立决定因素，而仅通过对等容松弛时间的影响而起作用。年龄在正常人中是一个重要的影响因素，但这种影响在左心室肥厚中减弱，在缺血性心室疾病中消失。
Objective—To investigate factors during isovolumic relaxation that determine Doppler filling patterns in patients with left ventricular disease, and thus to identify the underlying mechanisms. Design—85 patients (50 ischaemic heart disease, 35 left ventricular hypertrophy due to aortic stenosis) and 26 controls were studied with Doppler and M mode echocardiography and phonocardiography. 16 patients underwent two studies on separate occasions, to find whether changes in isovolumic relaxation time were reflected by a change in the Doppler A/E ratio. Setting—A tertiary cardiac referral centre. Subjects—Patients referred for assessment of coronary artery disease or aorticstenosis with left ventricular hypertrophy. Main outcomes measures—Doppler filling velocities during early (E wave) and late (A wave) diastole and the A/E ratio, acceleration of the E wave, digitised M mode indices of incoordinate relaxation (change in cavity dimension before mitral valve opening and time from minimum dimension to mitral valve opening), isovolumic relaxation time, M mode measures of diastolic function after mitral valve opening (peak rate of posterior wall thinning and peak rate of dimension increase), and left ventricular end diastolic pressure. Results—A/E correlated with age in normal subjects (r = 0·74), to a lesser extent in left ventricular hypertrophy (r = 0·41), but not significantly in ischaemic heart disease. In all patients, isovolumic relaxation time was significantly and negatively correlated with the acceleration of the E wave, showing its fundamental relation to the force responsible for early diastolic filling (r = −0·71 for left ventricular hypertrophy, and −0·74 for ischaemic heart disease, p value < 0·01). In left ventricular hypertrophy and those ischaemic patients without left ventricular dilatation A/E was correlated both with isovolumic relaxation time (r = 0·68 and 0·60 respectively), and with incoordinate relaxation (r = 0·65 and 0·61). In those ischaemic patients with left ventricular dilatation, the influence of incoordination was lost and isovolumic relaxation time became the dominant influence upon A/E (r = 0·82). Weak correlations of end diastolic pressure and RR interval with A/E, became insignificant once isovolumic relaxation time had been taken into account. Isovolumic relaxation time and incoordination together accounted for over 50% of the variance in the A/E ratio in our patients. Isovolumic relaxation time and the A/E ratio were linearly related. Patients with a short isovolumic relaxation time had evidence of considerable diastolic abnormalities, despite a normal Doppler A/E ratio. In the 16 patients who had two echocardiographic studies, changes in the duration of isovolumic relaxation were accompanied by a change in the Doppler A/E ratio. The relation between these two variables, derived from the group as a whole was similar. Conclusions—The main factors influencing the A/E ratio in patients with left ventricular disease are two distinct properties of isovolumic relaxation—namely the duration and the extent of incoordinate wall motion. Filling pressure and RR interval are not significant independent determinants, but act only through an effect upon isovolumic relaxation time. Age is an important influence in normal people, but this effect is attenuated in left ventricular hypertrophy and lost in ischaemic ventricular disease.
影响因子：
9.1
作者：
Yellin,EL;Nikolic,S;Frater,RW
通讯作者：
Frater,RW
左心室舒张期充盈多普勒指数的意义：与犬模型中的侵入性血流动力学比较。
影响因子：
4.8
作者：
Nishimura,RA;Abel,MD;Hatle,LK;HolmesJr,DR;Housmans,PR;Ritman,EL;Tajik,AJ
通讯作者：
Tajik,AJ