Passing Strange Flow in the Failing Ventricle
Passing Strange Flow in the Failing Ventricle
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DOI：
10.1161/circheartfailure.109.911867
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发表时间：
2010-03-01
影响因子：
9.7
通讯作者：
Bolger, Ann
中科院分区：
文献类型：
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作者：
Carlhall, Carl Johan;Bolger, Ann
心力衰竭的临床表现和病理生理学表现多种多样，包括腔室大小和容积、室壁运动、瓣膜功能、心内压和电事件的变化。这些都是常规测量与完善的方法。然而，尽管超声心动图显示心脏功能障碍的程度相似，但观察到不同程度的代偿是常见的。我们如何解释这一现象？我们对衰竭心脏的理解中的一个持续的差距是心内血流的整体行为及其对泵效率和疾病进展的潜在影响。心室充盈和射血是在时间和位置上不同的单独事件，每搏输出量的加速和射血仅是由于收缩期心肌收缩引起的事件，这些概念是熟悉的，但可能过于简单化。似乎合理的是，流动的血液将在充盈过渡到射血时保持移动，而不是在舒张末期停止，并且舒张末期左心室（LV）中的血液已经朝向主动脉瓣移动以进行射血是有效的。直到最近，还缺乏能够准确解决复杂的体内3D流场的测量工具来研究这些和其他基于流的问题。能够在整个心动周期内无创测量3D血流的新工具正变得越来越成熟，并且正在出现关于心内血流组织的更详细的观点。现在可以研究正常和衰竭心脏中流经心室的血液的路径、行为和相互作用1 -3，并考虑流动特性对心室功能效率的可能影响。关注心脏功能的流动方面使我们能够解决一系列新的补充问题。通过心脏的流动效率如何随着腔室尺寸、形状和壁特性而变化，以及异常收缩和舒张如何影响血液的通过？我们的几种心力衰竭治疗策略可能会对血流产生影响;因此，我们是否可能使用血流参数为心力衰竭患者选择最佳治疗、起搏模式和手术干预？
Heart failure is diverse in its manifestations and patho-physiology with changes in chamber size and volume, wall motion, valvular competence, intracardiac pressures, and electrical events. These are routinely measured with wellestablished methods. However, it is common to observe different degrees of compensation despite echocardiographically similar degrees of cardiac dysfunction. How can we explain this phenomenon? One persistent gap in our understanding of the failing heart is the global behavior of the intracardiac blood flow and its potential impact on pump efficiency and disease progression. The concepts that ventricular filling and ejection are separate events distinct in timing and location and that acceleration and ejection of the stroke volume are only events due to systolic myocardial contraction are familiar but likely oversimplified. It seems reasonable that rather than coming to a halt at end diastole, flowing blood would keep moving as filling transitions to ejection and that it would be efficient for blood in the end-diastolic left ventricle (LV) to already be moving toward the aortic valve for ejection. Until recently, there was a lack of measurement tools able to accurately resolve the complex in vivo 3D flow fields to investigate these and other flow-based questions. New tools that can measure 3D flow throughout the cardiac cycle noninvasively are becoming increasingly mature, and a more detailed perspective is emerging on the organization of intracardiac blood flow. It is now possible to investigate the routes, behaviors, and interactions of the blood transiting the ventricles in normal and failing hearts1–3 and to consider the possible impact of flow characteristics on the efficiency of ventricular function.A focus on the flow aspects of cardiac function allows us to address a new and complementary set of questions. How does the efficiency of flow through the heart change with chamber dimensions, shape, and wall properties, and how will the passage of blood be affected by abnormal contraction and relaxation? Several of our therapeutic strategies for heart failure could be expected to have implications with respect to flow; thus, is it possible that we might use flow parameters to select best therapies, pacing modes, and surgical interventions for our patients with heart failure?