Onbasili Alper O, Tekten Tarkan, Ceyhan Ceyhun, Piskin Tunca
Adnan Menderes University, School of Medicine, Department of Cardiology, Aydin, Turkey.
J Heart Valve Dis. 2004 Mar;13(2):188-96.
The results of previous studies have suggested that an increase in heart rate (HR) may have a beneficial effect on the hemodynamic condition of patients with aortic regurgitation (AR), and reduce AR severity. An increase in HR was shown to cause a significant increase in regurgitant slope and to significantly shorten the pressure half-time (PHT), both of which are considered to be signs of worsening regurgitation. Color M-mode Doppler flow propagation velocity (FPV) was used to assess AR severity, but no data were available regarding the effects of HR on FPV measurement of AR. The study aim was to evaluate the effect of HR on FPV, and to compare FPV and continuous-wave (CW) Doppler parameter (PHT and slope) variations resulting from an increase in HR.
Sixty-eight patients (28 males, 40 females; mean age 52 +/- 15 years) with AR of various severity were included. Color M-mode Doppler was used in FPV, while CW Doppler was used in PHT and slope measurements. Atropine sulfate was titrated in all patients to achieve at least a 20% increase in HR. The FPV, PHT, slope and regurgitant fraction (RF) of AR were measured before and after the increase in HR.
An increase in HR (77.8 +/- 8.9 versus 103 +/- 9.9 bpm; p < 0.001) caused a decrease in color M-mode Doppler FPV (51 +/- 21 versus 44 +/- 19 cm/s), in the PHT of the regurgitant velocity curve (468 +/- 154 versus 411 +/- 128 ms), and in the RF of the AR (30.2 +/- 16.3 versus 26.1 +/- 14%). The slope of the regurgitant velocity was increased (291 +/- 136 versus 358 +/- 122 cm/s2). All of these variations were statistically significant.
An increase in HR caused a decrease in the FPV and RF of the aortic regurgitation, and both changes were signs of improved regurgitation. FPV appears to be a more valuable parameter than CW Doppler parameters in determining improvements in AR resulting from an increase in HR.
既往研究结果提示，心率（HR）增加可能对主动脉瓣反流（AR）患者的血流动力学状况产生有益影响，并降低AR严重程度。研究表明，HR增加会导致反流斜率显著增加，压力半衰期（PHT）显著缩短，而这两者都被认为是反流恶化的征象。彩色M型多普勒血流传播速度（FPV）用于评估AR严重程度，但尚无关于HR对AR的FPV测量影响的数据。本研究旨在评估HR对FPV的影响，并比较HR增加导致的FPV与连续波（CW）多普勒参数（PHT和斜率）的变化。
纳入68例不同严重程度AR患者（男性28例，女性40例；平均年龄52±15岁）。FPV测量采用彩色M型多普勒，PHT和斜率测量采用CW多普勒。对所有患者静脉滴注硫酸阿托品，使HR至少增加20%。在HR增加前后测量AR的FPV、PHT、斜率和反流分数（RF）。
HR增加（77.8±8.9对103±9.9次/分；p<0.001）导致彩色M型多普勒FPV降低（51±21对44±19cm/s）、反流速度曲线的PHT降低（468±154对411±128ms）以及AR的RF降低（30.2±16.3对26.1±14%）。反流速度斜率增加（291±136对358±122cm/s²）。所有这些变化均具有统计学意义。
HR增加导致主动脉瓣反流的FPV和RF降低，且这两种变化均为反流改善的征象。在确定HR增加导致的AR改善方面，FPV似乎是比CW多普勒参数更有价值的参数。
