Maeda S, Katsura H, Chida K, Imai T, Kuboki K, Watanabe C, Kida K, Ohkawa S, Matsushita S, Ueda K
Division of Cardiology and Pulmonology, Tokyo Metropolitan Geriatric Hospital, Japan.
Br Heart J. 1991 Mar;65(3):132-6. doi: 10.1136/hrt.65.3.132.
The correlation between P pulmonale and right atrial overload in chronic lung disease was studied. Right atrial pressure, pulmonary artery pressure, and cardiac output were measured with a Swan-Ganz catheter in nine patients with chronic lung disease and P pulmonale on the electrocardiogram (P wave amplitude of greater than or equal to 2.5 mm (0.25 mV) in leads II, III, and a VF. The results were compared with those in six patients with an atrial septal defect (left to right shunt greater than or equal to 50%) and six patients with pulmonary hypertension (mean pressure greater than or equal to 30 mm Hg without left sided heart disease). Right atrial volume and wall thickness were measured in 10 cases of P pulmonale among 1000 necropsy cases and compared with 141 normal hearts from the same series. The patients with P pulmonale did not show a significant increase in right atrial or pulmonary artery pressures. None of the patients with an atrial septal defect or pulmonary hypertension had P pulmonale on the electrocardiogram. In the necropsy cases of P pulmonale mean (1 SD) in right atrial volume (32 (12) ml) and wall thickness (1.5 (0.7) mm) were not significantly increased (40 (14) ml and 1.4 (0.5) mm in the normal hearts). There was a significant inverse relation between the presence of P pulmonale and the cardiothoracic ratio. In all the patients with P pulmonale chest x ray showed a low cardiothoracic ratio, a considerably depressed diaphragm, and a pendulous heart. This study showed no correlation between P pulmonale and right atrial overload in chronic lung disease. A more vertical anatomical position of the heart, particularly of the right atrium, seems to be the major factor responsible for generation of P pulmonale in chronic airways disease.
研究了慢性肺病中肺型P波与右心房负荷过重之间的相关性。使用Swan-Ganz导管对9例慢性肺病且心电图有肺型P波（II、III和aVF导联P波振幅大于或等于2.5mm（0.25mV））的患者测量右心房压力、肺动脉压力和心输出量。将结果与6例房间隔缺损（左向右分流大于或等于50%）患者和6例肺动脉高压（平均压力大于或等于30mmHg且无左心疾病）患者的结果进行比较。在1000例尸检病例中的10例肺型P波患者中测量右心房容积和壁厚度，并与同一系列的141例正常心脏进行比较。肺型P波患者的右心房或肺动脉压力没有显著增加。房间隔缺损或肺动脉高压患者中没有心电图显示肺型P波的。在肺型P波的尸检病例中，右心房容积平均（1个标准差）为（32（12）ml），壁厚度为（1.5（0.7）mm），没有显著增加（正常心脏为40（14）ml和1.4（0.5）mm）。肺型P波的存在与心胸比率之间存在显著的负相关。所有肺型P波患者的胸部X线显示心胸比率低、膈肌明显压低和心脏下垂。本研究表明慢性肺病中肺型P波与右心房负荷过重之间没有相关性。心脏，特别是右心房更垂直的解剖位置似乎是慢性气道疾病中产生肺型P波的主要因素。
