特发性与缺血性扩张型心肌病中的左心房收缩储备

Left atrial systolic reserve in idiopathic vs. ischaemic-dilated cardiomyopathy.

作者信息

Moyssakis I, Papadopoulos D P, Kelepeshis G, Gialafos E, Votteas V, Triposkiadis F

机构信息

Laico General Hospital of Athens, Athens, Greece.

出版信息

Eur J Clin Invest. 2005 Jun;35(6):355-61. doi: 10.1111/j.1365-2362.2005.01505.x.

DOI:10.1111/j.1365-2362.2005.01505.x

PMID:15948895

Abstract

PURPOSE

There are studies indicating more pronounced left atrial (LA) systolic dysfunction at rest in idiopathic (IDDC) than in ischaemic-dilated cardiomyopathy (ISDC). It was hypothesized that the findings would be similar with regards LA systolic reserve.

METHODS

Twenty-six patients with IDDC, 28 with ISDC and 25 normal controls underwent low-dose dobutamine stress echocardiography (5-10 microg kg(-1) min(-1) IV). Left atrial volumes were echocardiographically determined at rest and during stress at the mitral valve opening (maximal, Vmax), electrocardiographic P wave (onset of atrial systole, Vp) and mitral valve closure (minimal, Vmin) from the apical 4- and 2-chamber views (biplane area-length method). Left atrial systolic function was assessed with the LA-active emptying volume (ACTEV) = Vp-Vmin and fraction (ACTEF) = ACTEV/Vp.

RESULTS

Vmax at rest was similar in IDDC and ISDC and greater than in the controls (54.2 +/- 12 vs. 48.5 +/- 18 vs. 27.1 +/- 6.3 cm(3) m(-2), respectively, P < 0.001) and did not change with stress (53.9 +/- 13.8 vs. 46.9 +/- 16.2 vs. 25.8 +/- 5.9 cm(3) m(-2), P < 0.001). The ACTEV at rest was similar in IDDC and ISDC and greater than in the controls (8.6 +/- 3.5 vs. 9.7 +/- 2.9 vs. 6.1 +/- 2.2 cm(3) m(-2) P < 0.01), whereas during the dobutamine infusion it remained unaltered in IDDC (10.8 +/- 4.6 cm(3) m(-2), P = NS vs. rest) and increased in ISDC (11.8 +/- 3.3 cm(3) m(-2), P < 0.05) and the controls (13.1 +/- 3.2 cm(3) m(-2), P < 0.01). The ACTEF was lower in IDDC than ISDC and the controls at rest (20 +/- 10% vs. 33 +/- 8% vs. 36 +/- 10%, P < 0.01). Dobutamine infusion was associated with no significant increase in ACTEF in IDDC (25 +/- 12%, P = NS vs. rest), and with an increase in this variable in ISDC (39 +/- 10%, P < 0.05) and the controls (49 +/- 12%, P < 0.01).

CONCLUSIONS

Dobutamine infusion is associated with an increase in LA ACTEV and fraction in ISDC and no significant change in these indices in IDDC. These findings indicate a reduced LA systolic reserve in IDDC.

摘要

目的

有研究表明，特发性扩张型心肌病（IDDC）患者静息时左心房（LA）收缩功能障碍比缺血性扩张型心肌病（ISDC）更明显。据推测，关于左心房收缩储备，结果会相似。

方法

26例IDDC患者、28例ISDC患者和25名正常对照者接受了低剂量多巴酚丁胺负荷超声心动图检查（静脉注射剂量为5 - 10μg·kg⁻¹·min⁻¹）。通过心尖四腔心和两腔心切面（双平面面积 - 长度法），在静息状态以及负荷状态下二尖瓣开放时（最大值，Vmax）、心电图P波时（心房收缩开始，Vp）和二尖瓣关闭时（最小值，Vmin），超声心动图测定左心房容积。用左心房主动排空容积（ACTEV）= Vp - Vmin和分数（ACTEF）= ACTEV / Vp评估左心房收缩功能。

结果

IDDC和ISDC患者静息时的Vmax相似且大于对照组（分别为54.2±12、48.5±18和27.1±6.3cm³·m⁻²，P < 0.001），负荷时无变化（分别为53.9±13.8、46.9±16.2和25.8±5.9cm³·m⁻²，P < 0.001）。IDDC和ISDC患者静息时的ACTEV相似且大于对照组（分别为8.6±3.5、9.7±2.9和6.1±2.2cm³·m⁻²，P < 0.01），而在多巴酚丁胺输注过程中，IDDC患者的ACTEV保持不变（10.8±4.6cm³·m⁻²，与静息时相比P = 无统计学意义），ISDC患者增加（11.8±3.3cm³·m⁻²，P < 0.05），对照组增加（13.1±3.2cm³·m⁻²，P < 0.01）。静息时，IDDC患者的ACTEF低于ISDC患者和对照组（分别为20±10%、33±8%和36±10%，P < 0.01）。多巴酚丁胺输注后，IDDC患者的ACTEF无显著增加（25±12%，与静息时相比P = 无统计学意义），ISDC患者增加（39±10%，P < 0.05），对照组增加（49±12%，P < 0.01）。