Seiler C, Jenni R, Krayenbuehl H P
Medical Policlinic, University Hospital, Zurich, Switzerland.
J Am Soc Echocardiogr. 1991 May-Jun;4(3):247-57. doi: 10.1016/s0894-7317(14)80024-2.
Forty patients with hypertrophic cardiomyopathy were investigated by Doppler echocardiography for intraventricular blood flow abnormalities. None had a bundle branch block. The patients were recruited on the basis of the presence of at least one of four different types of abnormal left ventricular blood flow movements during systole, isovolumetric relaxation, and diastole (time after mitral valve opening). The abnormal blood flow patterns were composed of the following: (1) systolic left ventricular outflow and midventricular obstruction in 20 of 40 and in 6 of 40 patients, respectively; (2) retrograde isovolumetric relaxation flow (IVRFretro; mean velocity, 0.7 +/- 0.3 m/sec), that is, flow toward the apex of the left ventricle, in 28 of 40 patients; (3) antegrade isovolumetric relaxation flow (IVRFante; mean velocity, 1.6 +/- 1.0 m/sec), that is, flow toward the left ventricular outflow tract, in 3 of 40 patients; and (4) diastolic antegrade flow (DFante; mean velocity, 0.9 +/- 0.3 m/sec), that is, flow opposite to mitral inflow, in 10 of 40 patients. There were significantly fewer patients with asymmetric septal hypertrophy (group 1) than with apical hypertrophic cardiomyopathy (group 2) showing DFante (1/29 versus 9/11, p less than 0.01). IVRFretro and DFante revealed higher velocities in patients with marked left ventricular asymmetric hypertrophy than in those with mild hypertrophy. Thus, in hypertrophic cardiomyopathy and especially in patients with marked asymmetric hypertrophy, there are different types of abnormal intraventricular blood flow movements during isovolumetric relaxation and disatole. This phenomenon is probably caused by asynchronous relaxation of the asymmetrically distributed, hypertrophied myocardium. DFante is more often observed in the apical cardiomyopathy than other forms of hypertrophic cardiomyopathy probably attributable to apically localized left ventricular cavity obliteration.
对40例肥厚型心肌病患者进行了多普勒超声心动图检查，以研究心室内血流异常情况。所有患者均无束支传导阻滞。这些患者是根据在收缩期、等容舒张期和舒张期（二尖瓣开放后时间）出现四种不同类型的异常左心室血流运动中的至少一种而入选的。异常血流模式包括以下几种：（1）40例患者中有20例出现收缩期左心室流出道梗阻和40例中有6例出现心室中部梗阻；（2）40例患者中有28例出现逆行等容舒张期血流（IVRFretro；平均速度，0.7±0.3米/秒），即血流朝向左心室心尖；（3）40例患者中有3例出现顺行等容舒张期血流（IVRFante；平均速度，1.6±1.0米/秒），即血流朝向左心室流出道；（4）40例患者中有10例出现舒张期顺行血流（DFante；平均速度，0.9±0.3米/秒），即与二尖瓣血流方向相反的血流。与表现出DFante的肥厚型心肌病（第2组）相比，不对称性室间隔肥厚患者（第1组）明显较少（1/29对9/11，p<0.01）。IVRFretro和DFante在左心室明显不对称肥厚患者中的速度高于轻度肥厚患者。因此，在肥厚型心肌病中，尤其是在明显不对称肥厚的患者中，等容舒张期和舒张期存在不同类型的异常心室内血流运动。这种现象可能是由不对称分布的肥厚心肌的异步舒张引起的。与其他形式的肥厚型心肌病相比，DFante在肥厚型心肌病中更常被观察到，这可能归因于左心室心尖部局限性腔室闭塞。
