Dardas P S, Filippatos G S, Tsikaderis D D, Michalis L K, Goudevenos I A, Sideris D A, Shapiro L M
Cardiac Unit, Papworth Hospital, Cambridge, UK.
J Am Soc Echocardiogr. 2000 Sep;13(9):809-17. doi: 10.1067/mje.2000.105579.
Our goal was to noninvasively assess left atrial diastolic function and its relation to the impaired left ventricular filling in patients with hypertrophic cardiomyopathy.
We studied 34 patients with hypertrophic cardiomyopathy, 26 patients with secondary forms of left ventricular hypertrophy (aortic stenosis, fixed subaortic stenosis, hypertension), and 21 control subjects. Left atrial diastolic function was assessed by measuring acceleration time (SAT), deceleration time (SDT), and the EF (mean deceleration rate) slope of the pulmonary venous flow systolic wave (SW). Left ventricular diastolic function assessed by transmitral Doppler included peak early left ventricular and peak atrial filling velocities, the ratio of early-to-late peak velocities, isovolumic relaxation time, deceleration time, and EF slope. In patients with hypertrophic cardiomyopathy, acceleration time was significantly reduced (P<.05), deceleration time was significantly prolonged (P<.0001), and EF slope was significantly reduced (P<.01). These indexes were similar among the other two groups. No statistically significant difference existed between the subgroups of hypertrophic cardiomyopathy in the above indexes. Patients with hypertrophic cardiomyopathy and secondary forms of left ventricular hypertrophy had evidence of left ventricular diastolic dysfunction. In patients with hypertrophic cardiomyopathy, no correlation existed between left atrial and left ventricular diastolic function indexes (r = -0.26 to 0.33).
Echocardiographic indexes of left atrial relaxation and filling are abnormal in patients with hypertrophic cardiomyopathy but not in secondary forms of left ventricular hypertrophy. These indexes are abnormal in all forms of hypertrophic cardiomyopathy irrespective of left ventricular outflow tract obstruction and distribution of hypertrophy; they are not solely attributable to left ventricular diastolic dysfunction. The above may imply that hypertrophic cardiomyopathy is a cardiac myopathic disease that involves the heart muscle as a whole, irrespective of distribution of hypertrophy and obstruction.
我们的目标是无创评估肥厚型心肌病患者的左心房舒张功能及其与左心室充盈受损的关系。
我们研究了34例肥厚型心肌病患者、26例继发性左心室肥厚（主动脉瓣狭窄、固定性主动脉瓣下狭窄、高血压）患者和21例对照者。通过测量肺静脉血流收缩波（SW）的加速时间（SAT）、减速时间（SDT）和EF（平均减速速率）斜率来评估左心房舒张功能。经二尖瓣多普勒评估的左心室舒张功能包括左心室早期峰值和心房充盈峰值速度、早期与晚期峰值速度之比、等容舒张时间、减速时间和EF斜率。肥厚型心肌病患者的加速时间显著缩短（P<0.05），减速时间显著延长（P<0.0001），EF斜率显著降低（P<0.01）。其他两组的这些指标相似。肥厚型心肌病亚组之间在上述指标上无统计学显著差异。肥厚型心肌病患者和继发性左心室肥厚患者均有左心室舒张功能障碍的证据。在肥厚型心肌病患者中，左心房和左心室舒张功能指标之间无相关性（r = -0.26至0.33）。
肥厚型心肌病患者的左心房舒张和充盈的超声心动图指标异常，但继发性左心室肥厚患者无异常。这些指标在所有类型的肥厚型心肌病中均异常，无论是否存在左心室流出道梗阻和肥厚分布情况；它们并非仅归因于左心室舒张功能障碍。上述情况可能意味着肥厚型心肌病是一种累及整个心肌的心肌病，与肥厚分布和梗阻情况无关。
