Correction for preload in assessment of myocardial contractility in aortic and mitral valve disease. Application of the concept of systolic myocardial stiffness.
Correction for preload in assessment of myocardial contractility in aortic and mitral valve disease. Application of the concept of systolic myocardial stiffness.
复制标题
主动脉瓣和二尖瓣疾病心肌收缩力评估中前负荷的校正。
DOI：
10.1161/01.cir.78.1.68
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发表时间：
1988
期刊：
影响因子：
37.8
通讯作者：
Krayenbuehl,HP
中科院分区：
文献类型：
--
作者：
Mirsky,I;Corin,WJ;Murakami,T;Grimm,J;Hess,OM;Krayenbuehl,HP
通过单次搏动分析，应用心肌收缩刚度的新概念，为评价主动脉瓣和二尖瓣病变的心肌收缩力提供了一种新的方法。70例患者接受了诊断性右心和左心导管插入术。26例患者患有主动脉瓣狭窄，18例患有主动脉瓣关闭不全，26例患有二尖瓣关闭不全。根据左心室质量指数小于172 g/m2（AS 1）和质量指数大于或等于172 g/m2（AS 2）将主动脉瓣狭窄患者分为两组。二尖瓣返流患者分为正常窦性心律（MR 1）和房颤（MR 2）。9例无明显冠状动脉或心血管疾病的患者作为对照。13例主动脉瓣狭窄和8例主动脉瓣关闭不全患者在成功的主动脉瓣置换术后接受了评价（平均约18个月）。同时左心室压力和电影血管造影的方法，心肌收缩力进行了评估，通过传统的射血分数后负荷的关系（未校正前负荷）和两种新的方法，允许校正前负荷的射血分数。在20-40%的研究病例中，这两种新方法对收缩状态的评估与传统方法不同。主动脉瓣狭窄和主动脉瓣关闭不全患者的收缩状态在术后得到改善，即使在术前收缩状态低下的患者中也是如此。在二尖瓣返流患者中，术前收缩功能存在相当大的异质性。主动脉瓣狭窄的严重左心室肥厚不是术后结果的标志，因为在AS 1和AS 2中，术后收缩力正常的人数相等。这项研究表明，前负荷校正是重要的，在术前评估收缩性的主动脉瓣和二尖瓣疾病，但它是不太重要的术后，大概是因为减少了前负荷。
With single-beat analysis, the new concept of systolic myocardial stiffness is applied to provide a new approach for the assessment of myocardial contractility in aortic and mitral valve disease. Seventy patients underwent diagnostic right and left heart catheterization. Twenty-six patients had aortic stenosis, 18 had aortic insufficiency, and 26 had mitral regurgitation. Patients with aortic stenosis were divided into two groups on the basis of left ventricular mass index less than 172 g/m2 (AS1) and mass index greater than or equal to 172 g/m2 (AS2). The mitral regurgitation patients were divided into those in normal sinus rhythm (MR1) and those in atrial fibrillation (MR2). Nine patients without significant coronary or cardiovascular disease served as controls. Thirteen patients with aortic stenosis and eight with aortic insufficiency were evaluated (average, approximately 18 months) after successful aortic valve replacement. With simultaneous left ventricular pressure and cineangiographic methods, myocardial contractility was assessed by the conventional ejection fraction-afterload relation (uncorrected for preload) and by two new methods that permit the correction of the ejection fraction for preload. Assessments of the contractile state by these two new methods differed from those by the conventional method in 20-40% of the cases studied. Contractile state improved postoperatively in aortic stenosis and aortic insufficiency even in patients with preoperative depressed contractile states. In patients with mitral regurgitation, there was considerable heterogeneity of contractile function preoperatively. Severe left ventricular hypertrophy in aortic stenosis was not a marker for postoperative outcome since contractility was normal postoperatively in AS1 and AS2 in equal numbers. This study demonstrates that preload correction is important in a preoperative assessment of contractility in aortic and mitral valve disease but that it is less important postoperatively, presumably because of reductions in the preload.