Ventricular interaction: from bench to bedside
Ventricular interaction: from bench to bedside
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DOI：
10.3109/07853890108998751
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发表时间：
2001-05-01
影响因子：
4.4
通讯作者：
Tyberg, JV
中科院分区：
文献类型：
--
作者：
Belenkie, I;Smith, ER;Tyberg, JV
右心室（RV）输出量减少导致左心室舒张末期容积（LVEDV）和串联相互作用输出量减少。直接心室相互作用也可能对LV功能产生重大影响。因此，右心室输出量减少引起的左心室舒张末容积减少可能会因室间隔移位和心包限制而进一步减少。这在急性和慢性肺动脉高压中是真实的，现在在严重充血性心力衰竭中也很明显。如果LV周围压力增加，则使用腔内LV舒张末期压（LVEDP）评估LVEDV是不合适的：应从LVEDP中减去周围压力，以计算控制前负荷的有效扩张（透壁）压力。如果周围压力增加超过LVEDP，则尽管LVEDP增加，但透壁LVEDP和LVEDV仍将减少。因此，使用充盈压来反映LVEDV的变化导致了关于心肌顺应性和收缩性变化的错误结论。现在清楚的是，尽管LVEDP增加，但容量负荷可能会减少肺栓塞、慢性肺病和严重充血性心力衰竭的LVEDV和每搏功。每搏功减少是LV前负荷减少的结果，而不是收缩性降低，如将充盈压用于反映前负荷所建议的。
Decreased right ventricle (RV) output results in decreased left ventricle end-diastolic volume (LVEDV) and output by series interaction. Direct ventricular interaction may also have a major effect on LV function. Thus, decreased LVEDV caused by reduced RV output may be further reduced by a leftward septal shift and pericardial constraint. This has been shown to be true in acute and chronic pulmonary hypertension and is now also apparent in severe congestive heart failure. The use of intracavitary LV end-diastolic pressure (LVEDP) to assess LVEDV is inappropriate if pressure surrounding the LV is increased: the surrounding pressure should be subtracted from LVEDP to calculate the effective distending (transmural) pressure which governs preload. If the surrounding pressure increases more than LVEDP, transmural LVEDP and LVEDV will decrease despite the increased LVEDP. Thus, the use of filling pressure to reflect changes in LVEDV has led to erroneous conclusions regarding changes in myocardial compliance and contractility. It is now clear that volume loading may reduce LVEDV and stroke work in pulmonary embolism, chronic lung disease and severe congestive heart failure despite increased LVEDP, The decreased stroke work is a result of reduced LV preload, not decreased contractility as would be suggested if filling pressure is used to reflect preload.