IMPROVEMENT IN EXERCISE CAPACITY AND EXERCISE HEMODYNAMICS 3 MONTHS AFTER DOUBLE-BALLOON, CATHETER BALLOON VALVULOPLASTY TREATMENT OF PATIENTS WITH SYMPTOMATIC MITRAL-STENOSIS
IMPROVEMENT IN EXERCISE CAPACITY AND EXERCISE HEMODYNAMICS 3 MONTHS AFTER DOUBLE-BALLOON, CATHETER BALLOON VALVULOPLASTY TREATMENT OF PATIENTS WITH SYMPTOMATIC MITRAL-STENOSIS
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DOI：
10.1161/01.cir.77.5.1013
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发表时间：
1988-05-01
期刊：
影响因子：
37.8
通讯作者：
RAHIMTOOLA, SH
中科院分区：
文献类型：
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作者：
MCKAY, CR;KAWANISHI, DT;RAHIMTOOLA, SH
在导管球囊瓣膜成形术（CBV）前和3个月随访时，对24例症状性二尖瓣狭窄患者的临床状态、运动平板性能和血流动力学进行了测定。静息时的血流动力学测定显示，通过双球囊技术进行的二尖瓣CBV导致平均肺动脉楔压（28 ± 1.5kPa）立即显著降低。7到16 .+-. 5 mm Hg，p <0.01）、平均肺动脉压（41 . ±. 11到33 .+-. 10 mm Hg，p < .05）和二尖瓣梯度（16 . ±. 7比6 .+-. 3 mm Hg，p <0.01），心输出量显著增加（4.3 ± 0.01）。1.1至5.0 .+-。1.4升/分钟，p <0.01）。二尖瓣面积从1.0 . ±. 0.3至2.2 .+-。0.72（p < .01）。二尖瓣面积无变化（2.0 . ±. 0.7 cm 2，p = NS）。在3个月随访导管插入术时，肺动脉楔压、肺动脉压和二尖瓣梯度持续较低。临床检查显示，CBV前24例患者中有21例患者为纽约心脏协会心功能III或IV级，CBV后3个月，22例患者为I或II级。在CBV之前，平均跑步机运动时间为5.9 ±。3.2 min，增加至9.8 ± 0.01。2.9随访3个月时，平均心率为1.5min（P <0.01）。CBV前和CBV后3个月在相同运动负荷和持续时间下的血流动力学测定的比较显示，尽管心率相似且心输出量增加（5.9 ± 0.01），1.7相对于6.9 .+-。1.5升/分钟，P <0.01），平均肺动脉楔压显著降低（42 . ± 0.01）。10比28 +-。10 mm Hg，p <0.01）、平均肺动脉压（61 . ±. 17比42 +-。12 mm Hg，p < .01）和二尖瓣梯度（27 . ±. 8比14 +-。7mm Hg，p < .01）。比较CBV前后3个月限制性仰卧自行车运动时的血流动力学测定结果表明，CBV前后运动时间（9.1 ± 0.05）min，3.2相对于17.1 .+-。3.7 min，p < .01）和工作负荷（43 . ±. 18.7相对于58.9 .+-。18.2 W，p <0.01）均增加。尽管心率显著增加（116 .+-. 23比127 .+-. 20次/分，p <0.01）和心输出量（5.9 . ±. 1.7 vs 8.0 .+-. 1.5升/分钟，p <0.01），平均肺动脉压（61 . ±. 17比42 +-。11 mm Hg，p < .01）和二尖瓣梯度（27 . ±. 8比16 +-。5 mm Hg，p <0.01）显著。CBV后3个月在两个运动水平下的血液动力学测定的比较（CBV后：Ex 1对CBV后：Ex 2）也表明心率显著增加（119 ± 0.01）。25比127 .+-. 20次/分，p <0.01）和心输出量（6.9 . ±. 1.5相对于8.0 .+-。1.5升/分钟，p <0.01）与肺动脉楔压的微小变化（28 . ±. 10比28 +-。9 mm Hg，p = NS）和肺动脉压（42 . ±. 12对42 +-。11 mm Hg，p = NS）。我们得出结论，通过双球囊技术进行的二尖瓣CBV导致二尖瓣面积增加，在3个月随访时持续存在，并与症状减轻、运动平板时间增加、仰卧位运动自行车性能增加以及静息和运动时血流动力学显著改善相关;后者为观察到的临床和运动平板改善提供了生理学解释。
Clinical status, exercise treadmill performance, and hemodynamics were determined in 24 patients with symptomatic mitral stenosis before catheter balloon valvuloplasty (CBV) and at 3 months follow-up. Hemodynamic deterninations at rest showed that mitral CBV performed by the double-balloon technique resulted in significant immediate decreases in mean pulmonary arterial wedge pressure (28 .+-. 7 to 16 .+-. 5 mm Hg, p < .01), mean pulmonary arterial pressure (41 .+-. 11 to 33 .+-. 10 mm Hg,p < .05), and mitral valve gradient (16 .+-. 7 to 6 .+-. 3 mm Hg, p < .01), and significant increases in cardiac output (4.3 .+-. 1.1 to 5.0 .+-. 1.4 liters/min, p < .01). Mitral valve area increased from 1.0 .+-. 0.3 to 2.2 .+-. 0.72 (p < .01). The mitral valve area was unchanged (2.0 .+-. 0.7 cm2, p = NS) at 3 months. The lower pulmonary arterial wedge pressure, pulmonary arterial pressure, and mitral valve gradient persisted at 3 month follow-up catheterization. Clinical examinations showed that before CBV, 21 of 24 patients were in New York Heart Association functional class III or IV; 3 months after CBV, 22 patients were in class I or II. Before CBV, the mean exercise treadmill time was 5.9 .+-. 3.2 min and it had increased to 9.8 .+-. 2.9 min (P < .01) by the 3 month follow-up. Comparisons of hemodynamic determinations at the same exercise workload and duration before CBV and 3 months after CBV showed that despite similar heart rates and increased cardiac outputs (5.9 .+-. 1.7 vs 6.9 .+-. 1.5 liters/min, p < .01), there were significant decreases in the mean pulmonary arterial wedge pressure (42 .+-. 10 vs 28 .+-. 10 mm Hg, p < .01), mean pulmonary arterial pressure (61 .+-. 17 vs 42 .+-. 12 mm Hg, p < .01), and mitral valve gradient (27 .+-. 8 vs 14 .+-. 7 mm Hg, p < .01). Comparisons of hemodynamic determinations at symptom-limited supine bicycle exercise before and 3 months after CBV showed that the exercise time (9.1 .+-. 3.2 vs 17.1 .+-. 3.7 min, p < .01) and workload (43 .+-. 18.7 vs 58.9 .+-. 18.2 W, p < .01) both increased. Despite significant increases in heart rate (116 .+-. 23 vs 127 .+-. 20 beats/min,p < .01) and cardiac output (5.9 .+-. 1.7 vs 8.0 .+-. 1.5 liters/min, p < .01), mean pulmonary arterial pressure (61 .+-. 17 vs 42 .+-. 11 mm Hg, p < .01), and mitral gradient (27 .+-. 8 vs 16 .+-. 5 mm Hg, p < .01) were significant. Comparisons of hemodynamic determinations at the two exercise levels 3 months after CBV(Post-CBV:Exl vs Post-CBV:Ex2) also demonstrated significant increases in heart rate (119 .+-. 25 vs 127 .+-. 20 beats/min, p < .01) and cardiac output (6.9 .+-. 1.5 vs 8.0 .+-. 1.5 liters/min, p < .01) associated with small changes in the pulmonary arterial wedge pressure (28 .+-. 10 vs 28 .+-. 9 mm Hg, p = NS) and pulmonary arterial pressure (42 .+-. 12 vs 42 .+-. 11 mm Hg, p = NS). We conclude that mitral CBV by the double-balloon technique resulted in increased mitral valve areas that persisted at 3 month follow-up and were associated with reduced symptoms, increased exercise treadmill time, increased supine exercise bicycle performance, and a significant improvement in hemodynamics both at rest and exercise; the latter provides a physiologic explanation for the observed clinical and treadmill improvement.