Giannuzzi P, Shabetai R, Imparato A, Temporelli P L, Bhargava V, Cremo R, Tavazzi L
Division of Cardiology, Medical Center of Rehabilitation, Veruno, Italy.
Circulation. 1991 Apr;83(4 Suppl):II155-65.
To assess the effects of mental stress on left ventricular diastolic function in patients with congestive heart failure, nine patients aged 57 +/- 12 years with dilated cardiomyopathy (end-diastolic volume, more than 110 ml/m2; ejection fraction, less than 40%; mean, 28 +/- 8%) and congestive heart failure in New York Heart Association functional class II or III and 14 normal volunteers (mean age, 49 +/- 8 years) were studied during mental arithmetic lasting 10 minutes with echocardiographic Doppler monitoring of transmitral flow velocity. During mental arithmetic, the ratio of peak flow velocity in early versus late diastole (E/A) and deceleration time of early diastole did not change in normal controls. However, E/A increased significantly (from 1.6 +/- 1.5 to 1.9 +/- 1.7; p less than 0.01) and deceleration time markedly decreased (from 156 +/- 49 to 108 +/- 31 msec; p less than 0.001) in patients with congestive heart failure. In 16 postinfarct patients with ejection fraction of less than 40% studied during mental arithmetic with simultaneous hemodynamics and Doppler recordings, good correlations were found between pulmonary wedge pressure and Doppler parameters (wedge pressure versus E/A, r = 0.89; wedge pressure versus deceleration time, r = -0.87). During mental arithmetic, the pulmonary wedge pressure-E/A correlation was weaker (r = 0.67), whereas the correlation between pulmonary wedge pressure and deceleration time was stronger (r = 0.91). The value of 153 msec in deceleration time was the best cutoff point in predicting 12 mm Hg pulmonary wedge pressure, both at rest and during mental arithmetic: the higher the deceleration time, the lower the pulmonary wedge pressure, and vice versa. Among patients with congestive heart failure, five showed normal baseline deceleration time (195 +/- 21 msec; pattern 1), and the remaining four showed a short (less than 153 msec) deceleration time (108 +/- 13 msec; pattern 2). During mental arithmetic, deceleration time markedly decreased to as short as 119 +/- 20 msec in all patients except one with baseline pattern 1. Deceleration time further decreased to 75 +/- 6 msec in all patients with baseline pattern 2. Mental arithmetic induces changes in left ventricular diastolic function in patients with congestive heart failure. Transmitral echocardiographic Doppler provides a simple noninvasive method of estimating and monitoring pulmonary wedge pressure in patients with severe left ventricular dysfunction.
为评估精神应激对充血性心力衰竭患者左心室舒张功能的影响，我们对9例年龄为57±12岁、患有扩张型心肌病（舒张末期容积超过110ml/m²；射血分数低于40%；平均为28±8%）且纽约心脏协会心功能分级为Ⅱ或Ⅲ级的充血性心力衰竭患者以及14名正常志愿者（平均年龄49±8岁）进行了研究。在持续10分钟的心算过程中，通过超声心动图多普勒监测二尖瓣血流速度。在心算过程中，正常对照组舒张早期与晚期峰值流速之比（E/A）及舒张早期减速时间未发生变化。然而，充血性心力衰竭患者的E/A显著增加（从1.6±1.5增至1.9±1.7；p<0.01），减速时间显著缩短（从156±49毫秒降至108±31毫秒；p<0.001）。在16例射血分数低于40%的心肌梗死后患者的心算过程中，同时进行血流动力学和多普勒记录，发现肺楔压与多普勒参数之间存在良好的相关性（肺楔压与E/A，r = 0.89；肺楔压与减速时间，r = -0.87）。在心算过程中，肺楔压与E/A的相关性较弱（r = 0.67），而肺楔压与减速时间的相关性较强（r = 0.91）。减速时间为153毫秒是预测静息及心算时12mmHg肺楔压的最佳临界点：减速时间越高，肺楔压越低，反之亦然。在充血性心力衰竭患者中，5例患者的基线减速时间正常（195±21毫秒；模式1），其余4例患者的减速时间较短（低于153毫秒）（108±13毫秒；模式2）。在心算过程中，除1例基线为模式1的患者外，所有患者的减速时间均显著缩短至119±20毫秒。所有基线为模式2的患者的减速时间进一步降至75±6毫秒。心算可引起充血性心力衰竭患者左心室舒张功能的改变。经二尖瓣超声心动图多普勒检查为严重左心室功能不全患者提供了一种简单的无创方法来估计和监测肺楔压。
