Peak Systolic Mitral Annulus Velocity Reflects the Status of Ventricular-Arterial Coupling-Theoretical and Experimental Analyses
Peak Systolic Mitral Annulus Velocity Reflects the Status of Ventricular-Arterial Coupling-Theoretical and Experimental Analyses
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DOI：
10.1016/j.echo.2011.01.010
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发表时间：
2011-05-01
影响因子：
6.5
通讯作者：
Sugimachi, Masaru
中科院分区：
文献类型：
--
作者：
Uemura, Kazunori;Kawada, Toru;Sugimachi, Masaru
背景：组织多普勒超声心动图测量的二尖瓣环收缩峰值速度(S-m)已被认为是心力衰竭患者和普通人群死亡率的独立预测因子。方法：建立了S-m的理论模型，认为左心室收缩功能和前负荷对S-m有正向影响，而左心室后负荷和射血时间对S-m有负向影响。在16只麻醉犬上，用声学测微仪和导管尖端测压技术测量了S-m、左心室容量和左心室压力。用收缩末压/容量比(E-Es‘)、舒张末容量(V-ed)和有效动脉弹性(E-a)分别评价左心室收缩功能、前负荷和后负荷。在广泛的范围内，获得了S-m(1.2-9.1 cm/s)、E-Es‘(1.5-17.6 mm Hg/m l)、V-ed(11-99 m L)、E-a(3.6-58.4 mm Hg/m l)、E-T(100-246ms)、心率(66-192次/m in)和室动脉偶联比(E-Es’/E-a)的76个数据集；结果：理论模型能准确预测S-m(R-2=0.79，P<；0.0001)。单因素相关分析显示，S-m与E-Es‘显著相关(R-2=0.64，P<0.0001)，与E-a倒数显著相关(R-2=0.49，P<0.01)。VED和ETT对S-m无明显影响。E-Es‘/E-a与S-m显著相关(R-2=0.73，P&t；0.0001)。E-Es‘和E-a倒数之间无相关性。结论：左心室收缩功能和后负荷独立决定S-m。尽管理论上与S-m有关，但左心室前负荷和左心室收缩末期压力对S-m的影响可能较小。S-m较强地反映了室动脉偶联状态。(J Am Soc超声心动图2011；24：582-91。)
Background: Peak systolic mitral annular velocity (S-m) measured by tissue Doppler echocardiography has been recognized as an independent predictor of mortality in patients with heart failure and in the general population. However, the mechanical determinants of S-m remain poorly defined.Methods: A theoretical model of S-m was derived, which indicates that S-m is affected positively by left ventricular (LV) contractility and preload and inversely by LV afterload and ejection time (EJT). In 16 anesthetized dogs, S-m, LV volume, and LV pressure were measured using sonomicrometry and catheter-tip micromanometry. LV contractility, preload, and afterload were indexed by the end-systolic pressure/volume ratio (E-es'), end-diastolic volume (V-ed), and effective arterial elastance (E-a), respectively. LV contractility, loading conditions, and heart rate were varied over wide ranges, and a total of 76 data sets were obtained for S-m (1.2-9.1 cm/sec), E-es' (1.5-17.6 mm Hg/mL), V-ed (11-99 mL), E-a (3.6-58.4 mm Hg/mL), EJT (100-246 msec), heart rate (66-192 beats/min), and the ventricular-arterial coupling ratio (E-es'/E-a; 0.2-3.0).Results: The theoretical model accurately predicted S-m (R-2 = 0.79, P < .0001). By univariate analysis, S-m was correlated significantly with E-es' (R-2 = 0.64, P < .0001) and with the reciprocal of E-a (R-2 = 0.49, P < .01). Ved and EJT did not affect S-m. E-es'/E-a was correlated strongly with S-m (R-2 = 0.73, P < .0001). E-es' and the reciprocal of E-a were not correlated with each other.Conclusions: LV contractility and afterload independently determine S-m. The effects of LV preload and EJT on S-m might be small, even though they are theoretically associated with S-m. S-m strongly reflects the status of ventricular-arterial coupling. (J Am Soc Echocardiogr 2011;24:582-91.)