The mechanism of emergence and clinical significance of apically directed intraventricular flow during isovolumic relaxation
The mechanism of emergence and clinical significance of apically directed intraventricular flow during isovolumic relaxation
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DOI：
10.1067/mje.2002.119113
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发表时间：
2002-07-01
影响因子：
6.5
通讯作者：
Kimura, G
中科院分区：
文献类型：
--
作者：
Ohte, N;Narita, H;Kimura, G
本文探讨了等容舒张期心尖向心室内血流的产生机制及其临床意义。本文对97例胸痛患者进行心导管检查，观察其血流空间分布与左室心尖部运动异常及左室功能的关系。根据血流分布情况，将患者分为以下3组：在乳头肌尖端和心尖之间的整个区域观察到血流（扩散性血流）（n = 38），在同一区域观察到血流但未充满整个区域（局部性血流）（n = 15），在该区域观察到无明显血流（无血流）（n = 44）。心尖部血流缺失。非同步性的敏感性为97%，特异性为87%。扩张血流患者左室舒张时间常数明显短于无血流患者。3组之间的收缩末期容积指数也存在显著差异（18.8 +/- 6.8 vs 30.9 +/- 7.7 vs 42.3 +/- 20.2 mL/m2，扩散血流<局部血流<无血流，P <0.05）。扩张血流患者左室舒张早期充盈血流的传播速度（47.0 +/- 8.3 cm/s）显著高于局限血流患者（30.7 +/- 7.8 cm/s）或无血流患者（28.6 +/- 7.8 cm/s）（P <0.001）。这些结果表明，较大幅度的LV弹性回缩和更快的LV舒张无LV心尖不同步的患者在等容舒张期间产生心尖定向的心室内血流，提高LV舒张早期充盈的速度。在等容舒张期心尖部定向的心室内血流可能作为更好的LV收缩性能和LV舒张至LV舒张早期充盈的介质发挥重要作用。在等容舒张期间缺乏心尖定向的心室内血流是从收缩末期到舒张早期LV心尖能量不齐和整体LV功能障碍的表现。
The mechanism of emergence and the clinical significance of apically directed intraventricular flow during isovolumic relaxation were investigated. The relation between the spatial distribution of the flow and left ventricular (LV) apical wall motion abnormality, as well as LV performance, was studied in 97 patients who underwent cardiac catheterization for evaluation of chest pain. According to the distribution of the flow, the patients were classified into the following 3 groups: flow observed in the whole area between the tip of the papillary muscle and the apex (spread flow) (n = 38), flow observed in the same area that did not fill the whole area (localized flow) (n = 15), and no apparent flow observed in the area (without flow) (n = 44). An absence of flow disclosed apical. asynergy with a sensitivity of 97% and specificity of 87%. The time constant of LV relaxation was significantly shorter in patients with spread flow than in those without flow. A significant difference was also observed in end-systolic volume index (18.8 +/- 6.8 vs 30.9 +/- 7.7 vs 42.3 +/- 20.2 mL/m(2), spread flow < localized flow < without flow, P < .05) among the 3 groups. The propagation velocity of LV early diastolic filling flow was significantly greater in patients with spread flow (47.0 +/- 8.3 cm/s) than in those with localized flow (30.7 +/- 7.8 cm/s) or without flow (28.6 +/- 7.8 cm/s) (P < .001). These findings indicate that the greater magnitude of LV elastic recoil and the faster LV relaxation in patients without LV apical asynergy produce apically directed intraventricular flow during isovolumic relaxation, enhancing the speed of LV early diastolic filling. Apically directed intraventricular flow during isovolumic relaxation may play an important role as a mediator of better LV systolic performance and LV relaxation to LV early diastolic filling. Absence of apically directed intraventricular flow during isovolumic relaxation is a manifestation of LV apical asynergy and global LV dysfunction from end systole to early diastole.