Ventricular Performance, Pump Function and Compensatory Mechanisms in Patients with Aortic Stenosis
Ventricular Performance, Pump Function and Compensatory Mechanisms in Patients with Aortic Stenosis
复制标题
主动脉瓣狭窄患者的心室性能、泵功能和代偿机制
DOI：
10.1161/01.cir.62.3.576
复制
发表时间：
1980
期刊：
影响因子：
37.8
通讯作者：
T. Kreulen
中科院分区：
文献类型：
--
作者：
J. Spann;A. Bove;T. Kreulen
当主动脉瓣狭窄导致慢性压力超负荷时，人心室的收缩能力仍然是一个主要争论的话题。用于维持正常静息心输出量和射血分数的代偿机制，以及代偿机制与症状的关系尚未得到充分证实。在这份报告中，我们研究了心室性能和代偿机制的关系，在11例严重的主动脉瓣狭窄和充血性心力衰竭症状（ASCHF组），在10例严重的主动脉瓣狭窄，但没有心力衰竭症状（AS-C组），并在12名正常人的症状。主动脉瓣狭窄患者的后负荷、前负荷和壁厚的改变可能会对收缩功能指标的有效性产生不利影响，因此我们试图解释或避免这种改变的影响。心室容积的自然变化被用来估计组心室功能的关系，收缩期壁应力峰值舒张末期容积指数（Frank-Starling），并估计组收缩末期压力或应力收缩末期容积（Sagawa）的关系。估计Frank-Starling指数和Sagawa指数的线性回归线的斜率显示AS-CHF患者的左心室收缩功能在统计学上显著降低（p < 0.01），而AS-C患者的心室收缩功能相对正常。舒张末期容积指数和压力仅在AS-CHF组显著增加（p < 0.01）。两组的收缩期左室壁应力峰值、射血分数、静息心脏指数和心室质量与体积的比值与正常值相比均无统计学差异。
The contractile capacity of the human ventricle when chronically pressure-overloaded by aortic stenosis remains a subject of major debate. The compensatory mechanisms used to maintain normal resting cardiac output and ejection fraction, and the relation of compensatory mechanisms to symptoms, have not been fully documented. In this report we examined ventricular performance and the relationship of compensatory mechanisms to symptoms in 11 patients with severe aortic stenosis and congestive heart failure symptoms (ASCHF group), in 10 patients with significant aortic stenosis but no heart failure symptoms (AS-C group), and in 12 normal subjects. Alterations in afterload, preload and wall thickness in aortic stenosis may adversely affect the validity of indexes of contractile function, so we attempted to account for or avoid the effect of such alterations. The natural variations in ventricular volume were used to estimate group ventricular function relationships relating peak systolic wall stress to end-diastolic volume index (Frank-Starling), and to estimate group relationships of end-systolic pressure or stress to end-systolic volume (Sagawa). The slope of the linear regression lines that estimated the Frank-Starling index and the Sagawa index showed statistically significant depression (p < 0.01) of left ventricular contractile function in the AS-CHF patients, while ventricular contractile function was relatively normal in the AS-C patients. End-diastolic volume index and pressure were significantly increased (p < 0.01) only in the AS-CHF group. Peak systolic left ventricular wall stress, ejection fraction, resting cardiac index, and the ratio of ventricular mass to volume were not statistically different from normal in either group.