Noninvasive estimation of transmitral pressure drop across the normal mitral valve in humans: Importance of convective and inertial forces during left ventricular filling
Noninvasive estimation of transmitral pressure drop across the normal mitral valve in humans: Importance of convective and inertial forces during left ventricular filling
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DOI：
10.1016/s0735-1097(00)00963-3
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发表时间：
2000-11-15
影响因子：
24
通讯作者：
Thomas, JD
中科院分区：
文献类型：
--
作者：
Firstenberg, MS;Vandervoort, PM;Thomas, JD
目的 我们假设彩色 M 模式 (CMM) 图像可用于求解欧拉方程，产生沿扫描线的区域压力梯度，然后将其积分以产生不稳定的伯努利方程，并无创地估计二尖瓣压差的对流和惯性分量。背景脉冲和连续波多普勒速度测量在临床上常规用于评估狭窄和反流瓣膜的严重程度。然而，仅测量压力梯度的对流分量，从而忽略了惯性力的贡献，这可能是重要的，特别是对于非狭窄瓣膜。彩色 M 制提供了流经二尖瓣的时空表示。方法 在 8 名接受冠状动脉旁路移植术的患者中，使用二尖瓣 CMM 同步获得高保真左心房和心室压力测量值；I。数字录音。使用伯努利方程的非定常流动形式，根据 M 模式时空速度分布计算瞬时舒张期二尖瓣压力差，并将其与导管测量结果进行比较。 结果 从 16 个血流动力学阶段的 56 次心跳中，在无创压力差计算中包含惯性项 ([Deltap(l)](max) = 1.78 +/- 1.30 mm Hg）显着增加了与基于导管的测量的时间相关性（r = 0.35 r 0.24 与 0.81 +/- 0.15，p < 0.0001）。它还允许精确近似峰值压力差（[p(C+l)](max) = 0.95 [p(cath)](max) + 0.24，r = 0.96，p < 0.001，误差 = 0.08 +/- 0.54 mm Hg）。 结论 惯性力是正常二尖瓣最大压降的重要组成部分。这些可以使用 CMM 记录的二尖瓣血流进行无创准确估计，这应该可以提高对舒张期充盈和心脏功能的理解。 (C) 2000 年由美国心脏病学会发布。
OBJECTIVES We hypothesized that color M-mode (CMM) images could be used to solve the Euler equation, yielding regional pressure gradients along the scanline, which could then be integrated to yield the unsteady Bernoulli equation and estimate noninvasively both the convective and inertial components of the transmitral pressure difference.BACKGROUND Pulsed and continuous wave Doppler velocity measurements are routinely used clinically to assess severity of stenotic and regurgitant valves:es. However, only the convective component of the pressure gradient is measured, thereby neglecting the contribution of inertial forces, which may be significant, particularly for nonstenotic valves. Color M-made provides a spatiotemporal representation of flow across the mitral valve.METHODS In eight patients undergoing coronary artery bypass grafting, high-fidelity left atrial and ventricular pressure measurements were obtained synchronously with transmitral CMM;I. digital recordings. The instantaneous diastolic transmitral pressure difference was computed from the M-mode spatiotemporal velocity distribution using the unsteady flow form of the Bernoulli equation and was compared to the catheter measurements.RESULTS From 56 beats in 16 hemodynamic stages, inclusion of the inertial term ([Deltap(l)](max) = 1.78 +/- 1.30 mm Hg) in the noninvasive pressure difference calculation significantly increased the temporal correlation with catheter-based measurement (r = 0.35 r 0.24 vs. 0.81 +/- 0.15, p < 0.0001). It also allowed an accurate approximation of the peak pressure difference ([p(C+l)](max) = 0.95 [p(cath)](max) + 0.24, r = 0.96, p < 0.001, error = 0.08 +/- 0.54 mm Hg).CONCLUSIONS Inertial forces are significant components of the maximal pressure drop across the normal mitral valve. These can be accurately estimated noninvasively using CMM recordings of transmitral flow, which should improve the understanding of diastolic filling and function of the heart. (C) 2000 by the American College of Cardiology.