Sherrrid Mark V, Mahenthiran Jo, Casteneda Vilma, Fincke Rupert, Gasser Mohamed, Barac Ivan, Thayaparan Rose, Chaudhry Farooq A
Division of Cardiology, St. Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, New York, USA.
Am J Cardiol. 2006 Jan 1;97(1):106-12. doi: 10.1016/j.amjcard.2005.07.128. Epub 2005 Nov 15.
In this study, we measured diastolic septal perforator flow velocities by Doppler transthoracic echocardiography (TTE) in patients with hypertrophic cardiomyopathy (HCM). Using color-guided pulsed Doppler TTE, septal perforator flow velocity recordings were attempted in 69 patients and successfully recorded in 47 (68%). First, we compared 14 patients with HCM to 12 controls and to 11 patients with hypertension with left ventricular hypertrophy. Next, in 10 additional patients with HCM, we compared the septal velocities with the epicardial left anterior descending artery (LAD) velocities recorded during the same TTE study. In the patients with HCM, the peak septal diastolic velocities were twice that of the normal controls (88 +/- 40 vs 41 +/- 13 cm/s) and also higher than in hypertensive left ventricular hypertrophy (51 +/- 18 cm/s, p < 0.0001). All 10 patients with HCM showed a step-up of peak diastolic velocity from the LAD to the septal perforator from 41 +/- 9 to 72 +/- 17 cm/s (p < 0.0001). Three patients with HCM had surgical septal myectomy. These patients had luminal narrowings of the small intramural arteries at histopathologic examination. In conclusion, pulsed Doppler measurement of septal perforator flow velocities is feasible. In HCM, the epicardial coronary arteries enlarge to accommodate increased flow, and diastolic velocity is normalized. In contrast, the increased velocities in the septal branches of patients with HCM are similar to those previously observed in tunnel-like obstructions. These findings suggest that in HCM, notwithstanding an increase in coronary flow, hemodynamically significant narrowings are present in the septal branches. Doppler TTE may become useful for evaluation of abnormal intramural coronary flow in HCM.
在本研究中，我们通过经胸多普勒超声心动图（TTE）测量肥厚型心肌病（HCM）患者的舒张期间隔穿支血流速度。使用彩色引导脉冲多普勒TTE，对69例患者尝试记录间隔穿支血流速度，其中47例（68%）成功记录。首先，我们将14例HCM患者与12例对照者以及11例伴有左心室肥厚的高血压患者进行比较。接下来，在另外10例HCM患者中，我们将间隔速度与同一TTE检查期间记录的左前降支（LAD）心外膜速度进行比较。在HCM患者中，间隔舒张期峰值速度是正常对照者的两倍（88±40 vs 41±13 cm/s），也高于高血压左心室肥厚患者（51±18 cm/s，p<0.0001）。所有10例HCM患者均显示舒张期峰值速度从LAD到间隔穿支有升高，从41±9 cm/s升至72±17 cm/s（p<0.0001）。3例HCM患者接受了室间隔心肌切除术。这些患者在组织病理学检查中显示壁内小动脉管腔狭窄。总之，脉冲多普勒测量间隔穿支血流速度是可行的。在HCM中，心外膜冠状动脉扩张以适应增加的血流，舒张期速度恢复正常。相比之下，HCM患者间隔分支中增加的速度与先前在隧道样梗阻中观察到的相似。这些发现表明，在HCM中，尽管冠状动脉血流增加，但间隔分支中存在血流动力学上显著的狭窄。多普勒TTE可能有助于评估HCM中异常的壁内冠状动脉血流。
