Geske Jeffrey B, Sorajja Paul, Nishimura Rick A, Ommen Steve R
Mayo Clinic, Gonda 05-368, 200 First St SW, Rochester, MN 55905, USA.
Circulation. 2007 Dec 4;116(23):2702-8. doi: 10.1161/CIRCULATIONAHA.107.698985. Epub 2007 Nov 19.
Diastolic dysfunction is a major pathophysiological abnormality in hypertrophic cardiomyopathy (HCM). Doppler echocardiographic parameters correlate with left ventricular (LV) filling pressures in other diseases, but it is unclear whether these findings apply to patients with HCM, who have multiple complex interrelated events leading to diastolic dysfunction. This study compares Doppler echocardiographic estimates of filling pressures to direct measurements of left atrial pressure (LAP) via catheterization in 100 patients with HCM.
One hundred patients who were symptomatic with HCM (New York Heart Association class III/IV, 82%) underwent measurement of early diastolic transmitral flow velocity (E) and mitral annular velocities (e') with the use of transthoracic echocardiography within 48 hours of cardiac catheterization with direct measurement of LAP. In a subset of 42 patients, echocardiographic and catheterization measurements were performed simultaneously. Mean LAP directly correlated with medial E-e' ratio in the overall population (r=0.44, P<0.0001) and also in the subgroup of patients who had simultaneous echocardiographic and catheterization studies (r=0.28, P=0.07). However, scatter was present. A calculated mean LV filling pressure was derived from the E-e' ratio with the use of a previously described regression equation, and the 95% confidence limits of agreement with measured mean LAP exceeded +/-18 mm Hg both for the overall group and for the subgroup who had simultaneous studies. Similar results were obtained with the lateral E-e' ratio. Only 1 patient had a previously defined "normal" E-e' ratio of <8.
In symptomatic patients with HCM, Doppler echocardiographic estimates of LV filling pressure with the use of transmitral flows and mitral annular velocities correlate modestly with direct measurement of LAP. Given the complex nature of diastolic dysfunction in HCM, precise characterization of LV filling pressure in an individual patient cannot be determined with the use of these noninvasive parameters.
舒张功能障碍是肥厚型心肌病（HCM）的主要病理生理异常。在其他疾病中，多普勒超声心动图参数与左心室（LV）充盈压相关，但尚不清楚这些发现是否适用于HCM患者，他们存在多种复杂的相互关联事件导致舒张功能障碍。本研究比较了100例HCM患者通过多普勒超声心动图评估的充盈压与通过导管插入术直接测量的左心房压力（LAP）。
100例有症状的HCM患者（纽约心脏协会III/IV级，82%）在进行心脏导管插入术直接测量LAP的48小时内，接受经胸超声心动图测量舒张早期二尖瓣血流速度（E）和二尖瓣环速度（e'）。在42例患者的亚组中，同时进行了超声心动图和导管插入术测量。总体人群中，平均LAP与内侧E-e'比值直接相关（r = 0.44，P < 0.0001），在同时进行超声心动图和导管插入术研究的患者亚组中也相关（r = 0.28，P = 0.07）。然而，存在离散情况。使用先前描述的回归方程从E-e'比值得出计算的平均LV充盈压，总体组以及同时进行研究的亚组与测量的平均LAP的95%一致性界限均超过±18 mmHg。外侧E-e'比值也得到了类似结果。只有1例患者的E-e'比值先前定义为“正常”，即<8。
在有症状的HCM患者中，利用二尖瓣血流和二尖瓣环速度通过多普勒超声心动图评估的LV充盈压与LAP的直接测量有适度相关性。鉴于HCM舒张功能障碍的复杂性，使用这些非侵入性参数无法确定个体患者LV充盈压的精确特征。
