Significance of Doppler indices of diastolic filling of the left ventricle: comparison with invasive hemodynamics in a canine model.
Significance of Doppler indices of diastolic filling of the left ventricle: comparison with invasive hemodynamics in a canine model.
复制标题
左心室舒张期充盈多普勒指数的意义：与犬模型中的侵入性血流动力学比较。
DOI：
10.1016/0002-8703(89)90017-3
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发表时间：
1989
影响因子：
4.8
通讯作者：
Tajik,AJ
中科院分区：
文献类型：
--
作者：
Nishimura,RA;Abel,MD;Hatle,LK;HolmesJr,DR;Housmans,PR;Ritman,EL;Tajik,AJ
多普勒测量二尖瓣血流速度曲线已被提出作为表征左心室舒张充盈的方法。不同的速度曲线在人类不同的疾病状态和不同的负荷条件下有经验描述，但这些不同的多普勒参数与心室舒张特性的血流动力学测量之间的关系尚未得到充分阐明。在7只闭胸麻醉犬中，研究了不同负荷条件（预负荷减少、预负荷增加、后负荷增加）对多普勒二尖瓣血流速度和高保真左房左室压的影响。下腔球囊充气减少预负荷使E速度（舒张早期速度）从0.39±0.09 m/sec显著降低至0.29±0.10 m/sec (p< 0.01)，减速时间从131±18 msec延长至165±60 msec （p< 0.05）。注液增加预载荷使E速度从0.39±0.09 m/sec显著提高到0.49±0.10 m/sec (p< 0.001)，减速时间从131±18 msec缩短到95±15 msec （p< 0.001）。后负荷增加的影响是可变的，并依赖于左房压。E速与最大左房-左室压力梯度（r= 0.47,p< 0.001）和左室压力总变化（r= 0.68,p< 0.001）呈显著正相关，减速时间与这些参数呈负相关。时间常数tau与E速度之间没有整体关系，但根据不同的填充压力对数据进行检查时，出现了反比关系。这些结果表明，二尖瓣速度测量不应直接等同于舒张功能的其他测量。然而，在不同的加载条件下出现了不同的速度曲线，这有助于解释这些曲线的含义。
Doppler measurements of mitral flow velocity curves have been proposed as a method for characterizing diastolic filling of the left ventricle. Different velocity curves have been empirically described in different disease states and under differing loading conditions in humans, but relating these various Doppler parameters to hemodynamic measurements of ventricular diastolic properties has not been fully elucidated. The effect of differing loading conditions (preload reduction, preload increase, afterload increase) on the Doppler mitral flow velocity and high-fidelity left atrial-left ventricular pressures was examined in seven closed-chest, anesthetized dogs. Preload reduction by balloon inflation in the inferior vena cave resulted in significant decreases in E velocity (early diastolic velocity) from 0.39 ± 0.09 m/sec to 0.29 ± 0.10 m/sec (p< 0.01) and prolongation of deceleration time from 131 ± 18 msec to 165 ± 60 msec (p< 0.05). Preload increase by infusion of fluids resulted in a significant increase in E velocity from 0.39 ± 0.09 m/sec to 0.49 ± 0.10 m/sec (p< 0.001) and shortening of the deceleration time from 131 ± 18 msec to 95 ± 15 msec (p< 0.001). The effect of afterload increase was variable and was dependent upon the left atrial pressure. Significant but weak positive correlations were noted between E velocity and maximal left atrial-left ventricular pressure gradient (r= 0.47,p< 0.001) and total change in left ventricular pressure (r= 0.68,p< 0.001), with inverse relationships between the deceleration time and these parameters. There was no overall relationship between the time constant tau and the E velocity, but an inverse relationship emerged when the data were examined according to different filling pressures. These results indicate that none of the mitral velocity measurements should be directly equated with other measurements of diastolic function. However, distinct velocity curves emerged under differing loading conditions that help in interpreting the meaning of these curves.