TRANSMITRAL PRESSURE-FLOW VELOCITY RELATION - IMPORTANCE OF REGIONAL PRESSURE-GRADIENTS IN THE LEFT-VENTRICLE DURING DIASTOLE
TRANSMITRAL PRESSURE-FLOW VELOCITY RELATION - IMPORTANCE OF REGIONAL PRESSURE-GRADIENTS IN THE LEFT-VENTRICLE DURING DIASTOLE
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DOI：
10.1161/01.cir.78.3.661
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发表时间：
1988-09-01
期刊：
影响因子：
37.8
通讯作者：
LUDBROOK, PA
中科院分区：
文献类型：
--
作者：
COURTOIS, M;KOVACS, SJ;LUDBROOK, PA
通过同时测量左心房微压（LAP）和左心室压（LVP），以及多普勒超声心动图测定11只麻醉闭胸犬左心室局部舒张压差对传递压-血流关系的影响。在距离心尖2、4和6 cm的位置记录脑室内压力。在早期（心房前）舒张充盈时，这些部位之间的递质压力关系存在显著差异。从顶点到基部测量，最小LVP增加了（1.6 .+-）。0.7到3.1 .+。0.8 mm Hg，平均值+-。SD);第一次传递压力与最小LVP之间的时间间隔增加了（31.1%）。3到50 .+-。17毫秒);快速充填的LVP波斜率减小（71.4 +-）。13到26，+-。5毫米汞柱/秒)；最大正向（即LAP > LVP）透射压力梯度减小（3.6 +-）。1.3至2.1 .+-。0.7 mm Hg)；第1点和第2点压力交叉的时间间隔增加（71 .+-）。9到96，+-。13毫秒);在第2点和第3点之间，血清的反向（即LVP > LAP）梯度下降（101 .+-）。41到40 .+-。33毫米汞柱。msec)。在心房收缩期间，也注意到显著的区域心室顶点至基底梯度。LV - A波的斜率减小（26.1 +-）。10到16 .+-。4毫米汞柱/秒)；左室舒张末压下降（8.1±）。2.0 ~ 7.4和2.0 mm Hg)，近基底处的上冲程比近顶点处的上冲程早。在0.05水平上差异均显著。同时测量脑室内4cm部位的传递多普勒速度谱和传递压力。第一和第二压力交叉点之间的平均间隔以及早期快速充盈开始与最大e波速度之间的平均间隔在统计学上相似(81 .+-。13 vs. 85。12毫秒;NS);与早流加速相关的正向传递压力梯度的平均面积显著大于与早流减速相关的反向传递压力梯度的平均面积(133 .+-。36 vs. 80。46 msec .cntdot。毫米汞柱;P < 0.025)。最后，最小LVP前的平均前向透射压力梯度大于最小LVP前的平均前向梯度（2.3 .+-）。0.4 vs. 1.4。0.3 mm Hg；p < 0.001)，最小LVP前后的e波加速度有显著差异(887 .+-。230对455 .+-。116毫米汞柱/秒；P < 0.01)。因此，本研究1)证实了舒张期存在生理的、反向的压力梯度，2)表明正向和反向压力梯度的大小和时间是心室内压力测量位置的函数，3)表明心房对充盈的贡献导致的区域压力变化与舒张期早期充盈相反。4)表明多普勒E波的时间特征与透射压的时间特征有特定的关系。这些发现与在舒张早期，心室充盈通过机械吸血进入心室腔而增强，而在心房收缩期间，心室被动充盈的观点是一致的。
Effects of regional diastolic pressure differences within the left ventricular on the measured transmitral pressure-flow relation were determined by simultaneous micromanometric left atrial (LAP) and left ventricular pressure (LVP) measurements, and Doppler echocardiograms in 11 anesthetized, closed-chest dogs. Intraventricular pressure recordings at sites that were 2, 4, and 6 cm from the apex were obtained. Profound differences between these sites were noted in the transmitral pressure relation during early (preatrial) diastolic filling. In measurements from apex to base, minimum LVP increased (1.6 .+-. 0.7 to 3.1 .+-. 0.8 mm Hg, mean .+-. SD); the time interval between the first crossover of transmitral pressures and minimum LVP increased (31 .+-. 3 to 50 .+-. 17 msec); the slope of the rapid-filling LVP wave decreased (74 .+-. 13 to 26 .+-. 5 mm Hg/sec); the maximum forward (i.e., LAP > LVP) transmitral pressure gradient decreased (3.6 .+-. 1.3 to 2.1 .+-. 0.7 mm Hg); the time interval between the first and second points of transmitral pressure crossover increased (71 .+-. 9 to 96 .+-. 13 msec); and the sera of reversed (i.e., LVP > LAP) gradient between the second and third points of transmitral pressure crossover decreased (101 .+-. 41 to 40 .+-. 33 mm Hg .cntdot. msec). During atrial contraction, significant regional ventricular apex-to-base gradients were also noted. The slope of the LV A wave decreased (26 .+-. 10 to 16 .+-. 4 mm Hg/sec); LV end-diastolic pressure decreased (8.1 .+-. 2.0 to 7.4 and 2.0 mm Hg), and the upstroke of the LV A wave near the base was recorded earlier than near the apex. All differences were significant at the 0.05 level. Simultaneous transmitral Doppler velocity profiles and transmitral pressures were measured at the 4-cm intraventricular site. The average interval between the first and second points of pressure crossover and between the onset of early rapid filling and maximum E-wave velocity were statistically similar (81 .+-. 13 vs. 85 .+-. 12 msec; NS); and the average area of the forward transmitral pressure gradient associated with acceleration of early flow was significantly greater than the area of reversed gradient associated with deceleration of early flow (133 .+-. 36 vs. 80 .+-. 46 msec .cntdot. mm Hg; p < 0.025). Finally, the average forward transmitral pressure gradient before minimum LVP was greater than the average forward gradient present minimum LVP (2.3 .+-. 0.4 vs. 1.4 .+-. 0.3 mm Hg; p < 0.001), with significant differences in E-wave acceleration noted before and after minimum LVP (887 .+-. 230 vs. 455 .+-. 116 mm Hg/sec; p < 0.01). Thus, the present study 1) confirms the existence of physiological, reversed pressure gradients during diastole, 2) shows that the magnitude and timing of forward and reversed pressure gradients are a function of the site of intraventricular pressure measurements, 3) shows that the regional variations in pressure due to the atrial contribution to filling are opposite to that of early diastolic filling, 4) indicates that temporal features of the Doppler E wave are related in a specific manner to temporal features of transmitral pressure. These findings are consistent with the view that during early diastole, filling is augmented by the mechanical suction of blood into the ventricular cavity, whereas during atrial contraction, the ventricle is filled passively.