Hung Ming-Jui, Cherng Wen-Jin, Cheng Chi-Wen
Cardiology Section, Department of Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan.
Echocardiography. 2003 Nov;20(8):703-9. doi: 10.1111/j.0742-2822.2003.03007.x.
This study was designed to define the role of left atrial (LA) wall motion during left ventricular (LV) diastolic phase for patients with pseudonormal mitral inflow. We perform the M-mode of posterior aortic, indicating LA, wall motion, and Doppler echocardiography following cardiac catheterization among 71 patients with a ratio of early (E) to late mitral flow (A) >1. The amplitude of total LA wall motion (TM), early LA rapid emptying (EM), and late LA emptying (AM) during the LV diastolic phase were all derived from M-mode analysis. Study patients were classified into two distinct groups according to the LV end-diastolic pressure (EDP): patients with a LVEDP value < 15 mmHg (n = 36, normal group), and patients with a LVEDP value > or = 15 mmHg (n = 35, pseudonormal group). Values of AM (4.7 +/- 1.2 vs 5.5 +/- 1.2 mm) and AM/TM (0.43 +/- 0.07 vs 0.55 +/- 0.08) for the normal and pseudonormal groups, respectively, were significantly higher for the pseudonormal group, whereas EM (6.6 +/- 1.8 vs 4.8 +/- 1.4 mm), TM (11 +/- 3 vs 10 +/- 2 mm), EM/AM (1.41 +/- 0.46 vs 0.91 +/- 0.28), EM/TM (0.58 +/- 0.10 vs 0.48 +/- 0.07) were significantly higher for the normal group. Among these parameters, AM/TM correlated best with the time constant of LV isovolumic relaxation (r = 0.77, P < 0.001). Using an AM/TM ratio value of >0.5 as an indicator of LV diastolic function abnormality, the sensitivity, specificity, positive predictive values, and negative predictive values for the detection of pseudonormalization were 85%, 94%, 94%, and 87%, respectively. These findings suggest that the increased volume reduction of late LA emptying (AM/TM) during LV diastolic phase assessed by M-mode echocardiography is useful for evaluating pseudonormal mitral inflow.
本研究旨在明确左房（LA）壁运动在左室（LV）舒张期对二尖瓣血流呈伪正常化患者的作用。我们对71例二尖瓣血流早期（E）与晚期（A）比值>1的患者进行了心导管检查后，进行了主动脉后壁、左房壁运动的M型及多普勒超声心动图检查。左室舒张期左房壁总运动幅度（TM）、左房早期快速排空（EM）及左房晚期排空（AM）均通过M型分析得出。根据左室舒张末压（EDP）将研究患者分为两个不同组：左室舒张末压值<15 mmHg的患者（n = 36，正常组），以及左室舒张末压值≥15 mmHg的患者（n = 35，伪正常组）。伪正常组的AM值（4.7±1.2 vs 5.5±1.2 mm）及AM/TM值（0.43±0.07 vs 0.55±0.08）分别显著高于正常组，而正常组的EM值（6.6±1.8 vs 4.8±1.4 mm）、TM值（11±3 vs 10±2 mm）、EM/AM值（1.41±0.46 vs 0.91±0.28）、EM/TM值（0.58±0.10 vs 0.48±0.07）显著更高。在这些参数中，AM/TM与左室等容舒张时间常数的相关性最佳（r = 0.77，P<0.001）。以AM/TM比值>0.5作为左室舒张功能异常的指标，检测伪正常化的敏感性、特异性、阳性预测值及阴性预测值分别为85%、94%、94%及87%。这些发现提示，通过M型超声心动图评估的左室舒张期左房晚期排空容积减少增加（AM/TM）有助于评估二尖瓣血流伪正常化。
