ASSESSMENT OF LEFT-VENTRICULAR PERFORMANCE BY ONLINE PRESSURE-AREA RELATIONS USING ECHOCARDIOGRAPHIC AUTOMATED BORDER DETECTION
ASSESSMENT OF LEFT-VENTRICULAR PERFORMANCE BY ONLINE PRESSURE-AREA RELATIONS USING ECHOCARDIOGRAPHIC AUTOMATED BORDER DETECTION
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DOI：
10.1016/0735-1097(94)90527-4
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发表时间：
1994-01-01
影响因子：
24
通讯作者：
PINSKY, MR
中科院分区：
文献类型：
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作者：
GORCSAN, J;ROMAND, JA;PINSKY, MR
目标.本研究的目的是利用超声心动图自动边界检测技术，以类似于压力-容积分析的方式，通过在线压力-面积关系评价犬在体心脏的左心室功能。超声心动图自动边界检测可以测量心室腔面积作为容积指标，并可与压力接口以在线构建压力-面积环。8只麻醉开胸犬同时测定心室压力、主动脉流量和心室短轴面积。压力-面积环由与超声系统接口的计算机工作站构建。将下腔静脉（n = 8）和主动脉（n = 4）闭塞期间的每搏面积（最大面积-最小面积）和每搏力（积分P dA [P =压力; A =面积]）值分别与每搏量和每搏功估计值进行比较。用多巴酚丁胺输注（2 - 5 mg/kg体重/min）诱导变力性调节，然后输注普萘洛尔（2 - 5 mg）。计算每个时期的收缩末期和最大弹性以及前负荷可恢复的心搏力（心搏力与舒张末期面积）。心搏面积和心搏力的变化与腔静脉闭塞期间心搏量和心搏功估计值的变化显著相关（n = 8）（分别为r = 0.87 +/- 0.02，SEE = 8 +/- 1%和r = 0.90 +/- 0.03，SEE = 8 +/-2%）。在主动脉闭塞犬（n = 4）中，卒中面积变化与汇总数据的每搏输出量变化显著相关（r = 0.84，SEE = 8%，y = 1.0x + 3）。多巴酚丁胺输注可增加心室性能（n = 7）：收缩末期弹性30 +/- 11至67 +/- 24 mm Hg/cm 2（与对照值相比p < 0.02）;最大弹性37 +/- 11至82 +/- 26 mm Hg/cm 2（p < 0.02对比对照值）;预负荷可恢复冲程力81 +/- 24至197 +/- 92 mm Hg（p < 0.02对比对照值）。普萘洛尔输注组（n = 5）收缩末期弹性降低20 +/- 4至13 +/- 4 mm Hg/cm 2（p < 0.002与对照值相比）;最大弹性29 +/- 8至15 +/- 5 mm Hg/cm 2（p < 0.002与对照值相比）;预负荷可恢复冲程力66 +/- 14至40 +/- 9 mm Hg（p < 0.002与对照值相比）。在线压力-面积关系是一种潜在的有用手段，以评估左心室性能的方式，定量类似于压力-容积关系的预测反应。
Objectives. The purpose of this study was to evaluate left ventricular performance by on-line pressure-area relations using echocardiographic automated border detection in the in situ canine heart in a manner similar to pressure-volume analyses.Background. Echocardiographic automated border detection can measure ventricular cavity area as an index of volume and may be interfaced with pressure to construct pressure-area loops on-line.Methods. Eight anesthetized open chest dogs had simultaneous measurement of ventricular pressure, aortic flow and midventricular short-axis area. Pressure-area loops were constructed by a computer workstation interfaced with the ultrasound system. Stroke are (Maximal area - Minimal area) and stroke force (integral P dA [P = pressure; A = area]) values during inferior vena cava (n = 8) and aortic (n = 4) occlusions were compared with stroke volume and estimates of stroke work, respectively. Inotropic modulation was induced with dobutamine infusion (2 to 5 mg/kg body weight per min), followed by propranolol infusion (2 to 5 mg). End-systolic and maximal elastance and preload recruitable stroke force (stroke force versus end-diastolic area) were derived for each period.Results. Changes in stroke area and stroke force were significantly correlated with changes in stroke volume and estimates of stroke work during caval occlusion (n = 8) (r = 0.87 +/- 0.02, SEE = 8 +/- 1% and r = 0.90 +/- 0.03, SEE = 8 +/- 2%, respectively). In dogs with aortic occlusion (n = 4), changes in stroke area significantly correlated with changes in stroke volume for pooled data (r = 0.84, SEE = 8%, y = 1.0x + 3). Ventricular performance increased with dobutamine infusion (n = 7): end-systolic elastance 30 +/- 11 to 67 +/- 24 mm Hg/cm2 (p < 0.02 vs. control values); maximal elastance 37 +/- 11 to 82 +/- 26 mm Hg/cm2 (p < 0.02 vs. control values); preload recruitablle stroke force 81 +/- 24 to 197 +/- 92 mm Hg (p < 0.02 vs. control values). Decreases occurred with propranolol infusion (n = 5) end-systolic elastance 20 +/- 4 to 13 +/- 4 mm Hg/cm2 (p < 0.002 vs. control values); maximal elastance 29 +/- 8 to 15 +/- 5 mm Hg/cm2 (p < 0.002 vs. control values); preload recruitable stroke force 66 +/- 14 to 40 +/- 9 mm Hg (p < 0.002 vs. control values).Conclusions. On-line pressure-area relations are a potentially useful means to assess left ventricular performance in a manner that is quantitatively similar to the predicted responses of pressure-volume relations.