NONINVASIVE ASSESSMENT OF LEFT-VENTRICULAR DIASTOLIC FUNCTION BY PULSED DOPPLER ECHOCARDIOGRAPHY IN PATIENTS WITH HYPERTROPHIC CARDIOMYOPATHY
NONINVASIVE ASSESSMENT OF LEFT-VENTRICULAR DIASTOLIC FUNCTION BY PULSED DOPPLER ECHOCARDIOGRAPHY IN PATIENTS WITH HYPERTROPHIC CARDIOMYOPATHY
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DOI：
10.1016/s0735-1097(87)80264-4
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发表时间：
1987-10-01
影响因子：
24
通讯作者：
ARCE, J
中科院分区：
文献类型：
--
作者：
MARON, BJ;SPIRITO, P;ARCE, J
肥厚型心肌病是一种原发性心肌疾病，其症状经常是由于左心室松弛、充盈和顺应性受损引起的。在本研究中，应用多普勒超声心动图测量二尖瓣血流速度，从而无创性地评估111例肥厚型心肌病患者的左室舒张功能。肥厚型心肌病患者的舒张期舒张期和充盈期的各项多普勒指标与86例非心脏病对照组相比均有显著差异(p<；0.001)，即等容舒张期延长(94.+-)。24比78。+-。12毫秒)和舒张期早期血流速度峰值(244.5±-)。55对220。+-。28ms)，以及较慢的减速(3.4.+-.1.4比4.9+-。1.3m/s2)，舒张期最大血流速度降低(0.5m/s2)。0.2比0.6。+-0.1m/S)。作为舒张性受损和舒张期早期充盈受损的明显补偿，心房对左心室充盈的贡献增加，表现为舒张期晚期血流速度增加(0.4±-)。0.3比0.3。+-0.1m/S)，舒张期最大血流速度与舒张期晚期最大血流速度比值减小(1.4±-)。0.8比2.1。+-。0.9)。绝大多数肥厚型心肌病患者(111例中的91例[82%])根据多普勒波形显示左室舒张功能受损。有或无左室流出道梗阻(78%)或无左室流出道梗阻(83%)的患者，以及有(84%)或无心脏症状(80%)的患者，多普勒舒张期指数异常的频率与此相似。然而，非梗阻性肥厚型心肌病患者较梗阻性心肌病患者表现出更严重的舒张期多普勒指标改变。因此，通过多普勒超声心动图评估的异常舒张期表现在绝大多数肥厚型心肌病患者中是明显的，与心脏症状的存在或不存在或主动脉下压力梯度无关。肥厚型心肌病无症状患者出现舒张期异常的频率较高，提示在疾病的自然病程中，当功能受限尚不明显时，可能存在舒张期功能受损。
Hypertrophic cardiomyopathy is a primary myocardial disease in which symptoms may frequently result from impaired left ventricular relaxation, filling and compliance. In the present investigation, Doppler echocardiography was utilized to measure transmitral flow velocity and thereby assess left ventricular diastolic performance noninvasively in a group of 111 patients representative of the broad clinical spectrum of hypertrophic cardiomyopathy. In patients with hypertrophic cardiomyopathy, all Doppler indexes of diastolic relaxation and filling differed significantly (p < 0.001) from those obtained in 86 control subjects without heart disease, namely, prolongation of isovolumic relaxation (94 .+-. 24 versus 78 .+-. 12 ms) and of the early diastolic peak of flow velocity (244 .+-. 55 versus 220 .+-. 28 ms), as well as slower deceleration (3.4 .+-. 1.4 versus 4.9 .+-. 1.3 m/s2) and reduced maximal flow velocity in early diastole (0.5 .+-. 0.2 versus 0.6 .+-. 0.1 m/s). As an apparent compensation for impaired relaxation and early diastolic filling, the atrial contribution to left ventricular filling was increased, as shown by increased late diastolic flow velocity (0.4 .+-. 0.3 versus 0.3 .+-. 0.1 m/s) and reduced ratio of maximal flow velocity in early diastole to that in late diastole (1.4 .+-. 0.8 versus 2.1 .+-. 0.9). The vast majority of patients with hypertrophic cardiomyopathy (91 [82%] of 111) showed evidence of impaired left ventricular diastolic performance, as assessed from the Doppler waveform. Abnormal Doppler diastolic indexes were identified with siilar frequency in patients with (78%) or without (83%) left ventricular outflow obstruction, as well as in patients with (84%) or without (80%) cardiac symptoms. However, patients with nonobstructive hypertrophic cardiomyopathy showed more severe alterations in the Doppler indexes of diastolic function than did patients with obstruction. Thus, abnormal diastolic performance as assessed by Doppler echocardiography was apparent in the vast majority of the study patients with hypertrophic cardiomyopathy, independent of the presence or absence of cardiac symptoms or a subaortic pressure gradient. The high frequency with which diastolic abnormalities are identified in asymptomatic patients with hypertrophic cardiomyopathy suggests that impaired diastolic performance may be present at a time in the natural history of the disease when functional limitation is not yet evident.