DOPPLER-DERIVED MITRAL DECELERATION TIME OF EARLY FILLING AS A STRONG PREDICTOR OF PULMONARY CAPILLARY WEDGE PRESSURE IN POSTINFARCTION PATIENTS WITH LEFT-VENTRICULAR SYSTOLIC DYSFUNCTION
DOPPLER-DERIVED MITRAL DECELERATION TIME OF EARLY FILLING AS A STRONG PREDICTOR OF PULMONARY CAPILLARY WEDGE PRESSURE IN POSTINFARCTION PATIENTS WITH LEFT-VENTRICULAR SYSTOLIC DYSFUNCTION
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DOI：
10.1016/0735-1097(94)90667-x
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发表时间：
1994-06-01
影响因子：
24
通讯作者：
GIORDANO, A
中科院分区：
文献类型：
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作者：
GIANNUZZI, P;IMPARATO, A;GIORDANO, A
目标.本研究旨在探讨重度左室收缩功能不全患者的多普勒二尖瓣血流速度与肺毛细血管楔压之间的相关性。异常舒张和室腔僵硬度增加对左室充盈模式有相反的影响。当这两种异常同时存在时，如收缩功能障碍患者中经常发生的那样，多普勒记录评估舒张功能和预测左心室充盈压的能力可能会显着受损。对140例射血分数≤ 35%的急性心肌梗死患者同时测定肺毛细血管楔压和多普勒血流速度。二尖瓣口舒张早期最大Bow流速与舒张晚期最大Bow流速比值（E/A比值）与肺毛细血管楔压相关性不强（r = 0.65）。E/A ≥ 2预测肺毛细血管楔压≥ 20 mm Hg的特异性高（99%），但敏感性低（43%）。相反，二尖瓣早期充盈减速时间与肺毛细血管楔压呈非常密切的负相关（r = -0.90）。减速时间≤ 120 ms预测肺毛细血管楔压≥ 20 mm Hg的敏感性为100%，特异性为99%。多普勒推导的早期充盈的二尖瓣减速时间提供了一种简单而准确的方法来估计肺毛细血管楔压，这在二尖瓣血流速度模式正常或正常化的患者中特别有用。
Objectives. The aim of this study was to investigate the correlations between Doppler-derived transmitral flow velocity variables and pulmonary capillary wedge pressure in patients with severe left ventricular systolic dysfunction.Background. Abnormal relaxation and increased chamber stiffness have opposing effects on the left ventricular filling pat tern. When both abnormalities are present at the same time, as often occurs in patients with systolic dysfunction, the ability of Doppler recording to assess diastolic function and predict left ventricular filling pressure may be significantly compromised.Method. Pulmonary capillary wedge pressure and Doppler transmitral Bow velocity profile were simultaneously recorded in 140 postinfarction patients with ejection fraction less than or equal to 35%.Results. Correlation between the ratio of mitral peak Bow velocity in early diastole to peak Bow velocity in late diastole (E/A ratio) and pulmonary capillary wedge pressure was weak (r = 0.65). Although the specificity of E/A greater than or equal to 2 in predicting greater than or equal to 20 mm Hg in pulmonary capillary wedge pressure was high (99%), its sensitivity was low (43%). Conversely, a very close negative correlation was found between mitral deceleration time of early filling and pulmonary capillary wedge pressure (r = -0.90). Sensitivity and specificity of less than or equal to 120 ms in deceleration time in predicting greater than or equal to 20 mm Hg in pulmonary capillary wedge pressure were 100% and 99%, respectively.Conclusions. Doppler derived mitral deceleration time of early filling provides a simple and accurate means of estimating pulmonary capillary wedge pressure that is particularly useful in patients with a normal or normalized mitral flow velocity pattern.