Ko Y G, Ha J W, Chung N, Shim W H, Kang S M, Rim S J, Jang Y, Cho S Y, Kim S S
Cardiology Division, Yonsei Cardiovascular Center & Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea.
Catheter Cardiovasc Interv. 2001 Mar;52(3):328-33. doi: 10.1002/ccd.1076.
In mitral stenosis (MS), left atrial (LA) pressure is commonly elevated because of increased LA afterload. There is a wide spectrum of LA pressure in patients with MS, however, despite a similar mitral valve orifice area. LA compliance is an important determinant of both cardiovascular performance and pathological physiology. Few data are available, however, regarding the effects of LA compliance on LA pressure. We hypothesized that LA pressure may be higher in patients with decreased LA compliance. We analyzed the right heart and transseptal catheterization data in 47 patients (41 female, mean age 40 +/- 10 years) with pure MS and sinus rhythm. The magnitude of LA a and v waves was measured from transseptal catheterization. Fick's method was used to determine cardiac output. LA compliance was calculated by dividing the systolic rise in LA pressure (DeltaP(LA) = P(LA(v)) - P(LA(x))) into the stroke volume. LA size, mitral valve area (MVA), mean diastolic pressure gradient (MG), left ventricular (LV) end-diastolic and end-systolic dimensions were obtained by using two-dimensional and Doppler echocardiography. Multiple regression analysis was performed to identify independent factors determining LA pressure. The mean MVA was 0.95 +/- 0.22 cm(2). MG and LA dimension were 11.2 +/- 5.2 mm Hg and 50.6 +/- 5.2 mm, respectively. The mean LA pressure and cardiac output obtained by cardiac catheterization were 23.4 +/- 8.4 mm Hg and 4.3 +/- 1.5 L/min, respectively. The calculated LA compliance was 4.9 +/- 2.8 cm(3)/mm Hg. Univariate analysis showed that factors associated with increased LA pressure were smaller MVA (r = -0.33, P < 0.05), higher MG (r = 0.69, P < 0.01) and lower LA compliance (r = -0.55, P < 0.01); among them, MG (beta coefficient 0.59, SE 0.19, P < 0.01) and LA compliance (beta coefficient -0.26, standard error 0.34, P < 0.05) were the strongest predictors of LA pressure. In conclusion, LA compliance, along with MG that reflects the severity of MS, is an important contributing factor determining LA pressure in patients with pure MS and sinus rhythm.
在二尖瓣狭窄（MS）中，由于左心房（LA）后负荷增加，左心房压力通常会升高。然而，尽管二尖瓣口面积相似，但MS患者的左心房压力范围很广。左心房顺应性是心血管功能和病理生理学的重要决定因素。然而，关于左心房顺应性对左心房压力影响的数据很少。我们假设左心房顺应性降低的患者左心房压力可能更高。我们分析了47例（41例女性，平均年龄40±10岁）单纯MS且窦性心律患者的右心和经房间隔导管检查数据。通过经房间隔导管检查测量左心房a波和v波的幅度。采用Fick法测定心输出量。左心房顺应性通过将左心房压力的收缩期升高（ΔP(LA)=P(LA(v))-P(LA(x))）除以每搏量来计算。使用二维和多普勒超声心动图获得左心房大小、二尖瓣面积（MVA）、平均舒张压梯度（MG）、左心室（LV）舒张末期和收缩末期内径。进行多元回归分析以确定决定左心房压力的独立因素。平均MVA为0.95±0.22cm²。MG和左心房内径分别为11.2±5.2mmHg和50.6±5.2mm。通过心导管检查获得的平均左心房压力和心输出量分别为23.4±8.4mmHg和4.3±1.5L/min。计算出的左心房顺应性为4.9±2.8cm³/mmHg。单因素分析显示，与左心房压力升高相关的因素包括较小的MVA（r=-0.33，P<0.05）、较高的MG（r=0.69，P<0.01）和较低的左心房顺应性（r=-0.55，P<0.01）；其中，MG（β系数0.59，标准误0.19，P<0.01）和左心房顺应性（β系数-0.26，标准误0.34，P<0.05）是左心房压力的最强预测因素。总之，左心房顺应性以及反映MS严重程度的MG是决定单纯MS且窦性心律患者左心房压力的重要因素。
