ACUTE HEMODYNAMIC INTERVENTIONS SHIFT DIASTOLIC PRESSURE-VOLUME CURVE IN MAN
ACUTE HEMODYNAMIC INTERVENTIONS SHIFT DIASTOLIC PRESSURE-VOLUME CURVE IN MAN
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DOI：
10.1161/01.cir.54.4.662
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发表时间：
1976-01-01
期刊：
影响因子：
37.8
通讯作者：
GLANTZ, SA
中科院分区：
文献类型：
--
作者：
ALDERMAN, EL;GLANTZ, SA
对16例患者[4例正常，8例心脏病]血管造影片的逐帧分析显示，血流动力学干预能够产生舒张压-容积曲线的显著变化。血管紧张素升高血压并使整个压力-容积曲线上移，硝普钠降低血压并使曲线下移。间接测量7例患者的胸膜压力（通过食管压力）显示，胸膜压力变化太小，无法解释这些变化。根据先前在犬研究中验证的理论压力-容积方程分析结果，并未显示观察到的变化是心肌本身弹性急性变化的产物。同样的分析表明，作用于左心室的外部机械约束（如右心室压力、心包）的间接变化以及可能与充盈速率变化相关的粘弹性效应导致了压力-容积曲线随干预的变化。在血流动力学干预中，一般不能将特定体积与给定压力相关联，这一事实使人们对在Frank-Starling机制方面解释收缩事件时可互换地使用舒张末期压力与舒张末期纤维长度提出了质疑。
Frame-by-frame analysis of angiograms in 16 patients [4 normal, 8 heart disease] revealed that hemodynamic interventions are capable of producing substantial shifts in the diastolic pressure-volume curve. Angiotensin raises blood pressure and shifts the entire pressure-volume curve up, and nitroprusside lowers blood pressure and shifts the curve down. Indirect measurements of pleural pressure in 7 patients (via esophageal pressure) showed that pleural pressure changes were too small to account for these shifts. Analyzing the results in terms of a theoretical pressure-volume equation previously validated in dog studies did not show the observed shifts to be the product of acute changes in the elasticity of the myocardium itself. This same analysis suggested that indirect changes in the external mechanical constraints acting on the left ventricle such as the right ventricular pressure, the pericardium, and perhaps viscoelastic effects related to changes in filling rate account for the pressure-volume curve shifts with intervention. The fact that one cannot in general relate a specific volume to a given pressure in the face of hemodynamic interventions calls into question the use of end-diastolic pressure interchangeably with end-diastolic fiber length when interpreting systolic events in terms of the Frank-Starling mechanism.