Noninvasive assessment of intraventricular pressure difference in left ventricular dyssynchrony using vector flow mapping
Noninvasive assessment of intraventricular pressure difference in left ventricular dyssynchrony using vector flow mapping
复制标题
DOI：
10.1007/s00380-020-01664-3
复制
发表时间：
2020-07-06
影响因子：
1.5
通讯作者：
Nakatani, Satoshi
中科院分区：
文献类型：
--
作者：
Minami, Seina;Masuda, Kasumi;Nakatani, Satoshi
舒张期心室内压差（IVPD）反映左心室（LV）舒张功能。相对压力成像（RPI）能够基于矢量流图（VFM）和局部压力分布的可视化对IVPD进行无创定量。LV不同步导致心脏性能恶化。然而，目前尚不清楚IVPD是如何通过LV不同步调节的。通过右心室（RV）起搏在10只开胸犬中建立LV不同步。另10只犬行右心房（RA）起搏，设定与RV起搏相似的心率作为对照。超声心动图图像采集在基线和起搏过程中，同时用微压计测量左心室压力。用RPI法计算一个心动周期内左室流入道顶底压差（Δ P），并测量舒张期舒张期舒张时间Δ P（Δ P-IRT）和充盈早期Δ P（Δ P-E）。RV起搏期间，每搏输出量（SV）和Delta P（IRT）显著降低，而Delta P（E）与基线相比无变化。右心房起搏时每搏量、Δ P（IRT）、Δ P（E）无明显变化。Delta P（IRT）与-dP/dt（min）、收缩末期容积呈显著正相关，与射血分数呈显著正相关。等容舒张期的IVPD随左室不同步而降低，而充盈早期的IVPD则无此变化。在LV不同步中观察到舒张期抽吸减少，并且与SV减少显著相关。
Diastolic intraventricular pressure difference (IVPD) reflects left ventricular (LV) diastolic function. The relative pressure imaging (RPI) enables the noninvasive quantification of IVPD based on vector flow mapping (VFM) and visualization of regional pressure distribution. LV dyssynchrony causes deterioration of cardiac performance. However, it remains unclear how IVPD is modulated by LV dyssynchrony. LV dyssynchrony was created in ten open-chest dogs by right ventricular (RV) pacing. The other ten dogs undergoing right atrial (RA) pacing set at the similar heart rate with RV pacing were used as controls. Echocardiographic images were acquired at baseline and during pacing simultaneously with LV pressure measurement by a micromanometer. Pressure difference (Delta P) was computed between the apex and the base of the LV inflow tract during a cardiac cycle by RPI and Delta P during isovolumic relaxation time (Delta P-IRT), a parameter of diastolic suction, and that during early filling phase (Delta P-E) were measured. During RV pacing, stroke volume (SV) and Delta P(IRT)decreased significantly, while Delta P(E)did not change compared to the baseline. During RA pacing, SV, Delta P(IRT)and Delta P(E)did not change significantly. Delta P(IRT)tended to correlate with -dP/dt(min)and end-systolic volume, and significantly correlated with ejection fraction. IVPD during isovolumic relaxation time was decreased by LV dyssynchrony, while IVPD during early filling phase was not. A reduction of diastolic suction is observed in LV dyssynchrony and is significantly related to a decrease in SV.