Early diastolic left ventricular inflow pressures in normal subjects and patients with dilated cardiomyopathy. Reconstruction from pulsed Doppler echocardiography.
Early diastolic left ventricular inflow pressures in normal subjects and patients with dilated cardiomyopathy. Reconstruction from pulsed Doppler echocardiography.
复制标题
正常受试者和扩张型心肌病患者舒张早期左心室流入压。
作者：
S. Fujimoto;K. Parker;H. Xiao;K. S. Inge;D. Gibson
目的——评估正常受试者和扩张型心肌病患者的早期舒张期左心室流入压，从而评估恢复力的潜在效果。方法——用心室血液作为加速度计，通过脉冲多普勒超声心动图测量左心室内从二尖瓣环到心尖部以1cm间隔的速度，并对记录进行微分以获得加速度，重建舒张早期左心室流入压力。第二心音 (A2) 的主动脉成分用于确定相对时间。局部压力梯度由每个水平处的加速度确定，并且通过对局部增量求和来确定填充间隔的加速（+峰值PD）和减速（-峰值PD）阶段期间的总压降。还使用二尖瓣环水平的时间-速度积分确定左心室流出道的总每搏输出量（SV）和二尖瓣每搏距离（MSD）。因此，有效流孔面积为 SV/MSD。通过横截面彩色多普勒血流图估计穿过二尖瓣的流入射流宽度。患者——32 名患有二尖瓣 E 波或求和波占主导地位的扩张型心肌病患者，以及 24 名年龄相近的正常受试者。结果——扩张型心肌病的正常 + 峰值 PD 为 3.9 (SD 0.7) vs 7.4 (2.2) mm Hg (P < 0.01)。正常 - 心肌病患者的峰值 PD 为 2.5 (0.9) vs 5.6 (2.8) mm Hg（P < 0.01）。心肌病患者的正常有效流量孔口面积为 5.9 (1.3) vs 1.9 (0.8) [范围 0.9 约 3.7] cm2（P < 0.01）。这相当于正常情况下收缩末期横截面的 71 (18)%，而扩张型心肌病中则为 11 (6)%（P < 0.01）。心肌病患者的正常横截面彩色流入射流宽度为 2.7 (0.3) vs 1.5 (0.4) cm（P < 0.01）。射流宽度与根据有效流孔面积计算的流动宽度相关（r = 0.82，P < 0.01）。结论——（1）舒张早期总正负峰值压降通常较低，因此不需要显着的左心室负压来解释正常的静息早期舒张二尖瓣血流速度。 (2) 这些低压降只有在接近收缩末期左心室腔面积的大有效孔口面积的情况下才可能实现。 (3) 扩张型心肌病的房室压下降要大得多，其中流入加速度增加是由于有效流量孔口面积减少。这些干扰将损害充盈，而与任何松弛或顺应性异常无关。
OBJECTIVE--To estimate early diastolic left ventricular inflow pressures in normal subjects and patients with dilated cardiomyopathy, and thus to assess the potential effect of restoring forces. METHODS--Early diastolic left ventricular inflow pressures were reconstructed using the ventricular blood as an accelerometer, by measuring velocity at 1 cm intervals within the left ventricle from mitral ring to apex by pulsed Doppler echocardiography, and differentiating the records to obtain the acceleration. Aortic component of second heart sound (A2) was used to fix relative timings. The local pressure gradient was determined from the acceleration at each level, and the total pressure drop during the acceleration (+ peak PD) and deceleration (- peak PD) phases of the filling interval were determined by summing the local increments. The total stroke volume (SV) at the left ventricular outflow tract and the mitral stroke distances (MSD) were also determined, using the time-velocity integral at mitral ring level. Effective flow orifice area was thus SV/MSD. Inflow jet width across the mitral valve was estimated by cross sectional colour Doppler flow mapping. PATIENTS--32 patients with dilated cardiomyopathy with a dominant mitral E or summation wave, and 24 normal subjects of similar ages. RESULTS--Normal + peak PD was 3.9 (SD 0.7) v 7.4 (2.2) mm Hg in dilated cardiomyopathy (P < 0.01). Normal - peak PD was 2.5 (0.9) v 5.6 (2.8) mm Hg in cardiomyopathy (P < 0.01). Normal effective flow orifice area was 5.9 (1.3) v 1.9 (0.8) [range 0.9 approximately 3.7] cm2 in cardiomyopathy (P < 0.01). This corresponded to 71 (18)% of the end systolic cavity cross section in normals v 11 (6)% in dilated cardiomyopathy (P < 0.01). Normal cross sectional colour inflow jet width was 2.7 (0.3) v 1.5 (0.4) cm in cardiomyopathy (P < 0.01). The jet width correlated with flow width calculated from effective flow orifice area (r = 0.82, P < 0.01). CONCLUSIONS--(1) Total early diastolic positive and negative peak pressure drop are normally low, so that significant negative left ventricular pressures are not needed to explain normal resting early diastolic mitral flow velocities. (2) These low pressure drops are only possible with a large effective orifice area approaching end systolic left ventricular cavity area. (3) Atrioventricular pressure drops are much greater in dilated cardiomyopathy, where increased inflow accelerations are due to reduced effective flow orifice area. These disturbances will impair filling independently of any abnormality of relaxation or compliance.
影响因子：
37.8
作者：
LEWIS, JF;KUO, LC;QUINONES, MA
通讯作者：
QUINONES, MA
影响因子：
9.1
作者：
Yellin,EL;Nikolic,S;Frater,RW
通讯作者：
Frater,RW
影响因子：
37.8
作者：
COURTOIS, M;KOVACS, SJ;LUDBROOK, PA
通讯作者：
LUDBROOK, PA