Matsumoto Y, Morita H, Mizushige K, Nakajima S, Kan T, Sakamoto S, Senda S, Matsuo H
Second Department of Internal Medicine, Kagawa Medical School.
J Cardiol. 1990;20(4):977-89.
To obtain an index of left ventricular contractility, cardiac catheterization is necessary. In the present study, we ascertained whether max(dP/dt) could be obtained noninvasively in vivo based on the theoretical equation, max(dP/dt) not equal to rho cmax(du/dt), where rho is the density of blood, c is the pulse wave velocity of the aorta and max(du/dt) is the maximum acceleration of the aortic blood flow. This equation is based on the theory of pulse wave propagation, and was established in animal experiments. We further attempted to clarify the clinical usefulness of rho cmax(du/dt) by examining the effects of afterload and preload on rho cmax(du/dt). Twenty-seven patients without stenosis of their aortic valves and left ventricular outflow tracts were observed. During cardiac catheterization, we measured max(dP/dt) using a catheter-tip micromanometer, max (du/dt) using pulsed Doppler echocardiography and pulse wave velocity by simultaneously recording the femoral pulse wave and the carotid pulse wave. The measurements were performed at rest, before and after an increase in contractility with dobutamine administration, an increase in afterload with methoxamine administration and an increase in preload by leg elevation. There was good linear correlation (Y = 0.95X + 7.51, r = 0.84, p less than 0.0005) between max(dP/dt)[X] and rho cmax(du/dt)[Y] at rest. When the contractility was changed, rho cmax(du/dt) reflected changing of max(dP/dt). Moreover, when the afterload and preload were increased, the changing pattern of rho cmax(du/dt) was similar to that of max(dP/dt). Max(du/dt), index of cardiac performance previously proposed, showed a different changing pattern than max(dP/dt), indicating that max(du/dt) was influenced substantially by loading conditions. These results indicated that we can obtain max(dP/dt) noninvasively and reliably by measuring rho cmax(du/dt).
为了获得左心室收缩性指标，心脏导管插入术是必要的。在本研究中，我们基于理论方程max(dP/dt)≠ρcmax(du/dt)（其中ρ是血液密度，c是主动脉脉搏波速度，max(du/dt)是主动脉血流的最大加速度），确定是否可以在体内非侵入性地获得max(dP/dt)。该方程基于脉搏波传播理论，并在动物实验中建立。我们进一步试图通过研究后负荷和前负荷对ρcmax(du/dt)的影响来阐明ρcmax(du/dt)的临床实用性。观察了27例无主动脉瓣和左心室流出道狭窄的患者。在心脏导管插入术期间，我们使用导管尖端微测压计测量max(dP/dt)，使用脉冲多普勒超声心动图测量max(du/dt)，并通过同时记录股动脉脉搏波和颈动脉脉搏波来测量脉搏波速度。测量在静息状态下进行，在给予多巴酚丁胺增加收缩性之前和之后、给予甲氧明增加后负荷之后以及通过抬高腿部增加前负荷之后进行。静息时max(dP/dt)[X]与ρcmax(du/dt)[Y]之间存在良好的线性相关性（Y = 0.95X + 7.51，r = 0.84，p＜0.0005）。当收缩性改变时，ρcmax(du/dt)反映了max(dP/dt)的变化。此外，当后负荷和前负荷增加时，ρcmax(du/dt)的变化模式与max(dP/dt)相似。先前提出的心脏功能指标max(du/dt)显示出与max(dP/dt)不同的变化模式，表明max(du/dt)受负荷条件的影响很大。这些结果表明，我们可以通过测量ρcmax(du/dt)非侵入性且可靠地获得max(dP/dt)。
