Modica G, Monte I, Licciardi S
yttedra di Cardiologia, Università degli Studi, Catania.
Cardiologia. 1990 May;35(5):391-400.
Aim of the study was to examine the role of echocardiography to classify patients with heart failure. Fifty-seven subjects (32 dilated cardiomyopathy (DCM), 9 aortic regurgitation (AR), 16 hypertensives (HT)--4 in Class (CI) NYHA I, 24 II, 15 III, 14 IV--were studied by M-2D echo. Eighty-seven normals (N) were the control group; 11 were controlled after clinical improvement (3.4 +/- 3.8 months); 11 after worsening (12 +/- 17). We have evaluated: left ventricular diastolic dimension (LVIDd), wall thickness/radius ratio (H/R), diastolic (D) and systolic volume (S Vol), ejection fraction (EF), systolic arterial pressure/end-systolic volume ratio (P/V), and stress. LVIDd and stress were increased in all groups; H/R reduced, except in HT and in Cl I; EF and P/V reduced except in Cl I. Between I and II LVIDd was different; between II and III all parameters were different, between III and IV only EF and P/V. According to regression S-D Vol, EF-P/V and EF-stress we identify the reduction of EF and the related mechanisms, ie reduced contractility or increased afterload. Thus, according to P/V and stress, we classify the patients in 4 pathopysiologic classes: 1 and 2 with P/V within 2 SD N: 1 with stress within 2SD N, EF and H/R normal; 2 with stress greater than +2SD, H/R normal and EF reduced; 3 and 4 with P/C less than -2 SD N: 3 with normal, 4 with stress greater than +2 SD. In the 1 and 2, 1 out 14 is in III Cl NYHA, none in IV; in 3,6 out 8 are in II, in 4, 9 out 35 are in Cl less than III. In the follow-up, in 8 of the improved patients, EF and P/V were increased and stress reduced; in 3, EF was reduced. In 8 of the worsened, EF and P/V were reduced, LVIDd and stress increased; in 3 EF and LVIDd were increased, P/V reduced. This study demonstrates discordance between Cl NYHA and echo, and how classification of NYHA does not give information about the several components of heart failure. However LVID and EF are not sufficient. By a correlation of echo-parameters of contractility, afterload and pump performance, we may suggest a classification of heart failure in pathophysiologic classes.
本研究的目的是探讨超声心动图在心力衰竭患者分类中的作用。对57名受试者（32例扩张型心肌病（DCM）、9例主动脉瓣反流（AR）、16例高血压患者（HT）——纽约心脏协会（NYHA）心功能分级I级4例、II级24例、III级15例、IV级14例）进行了M-2D超声心动图检查。87名正常人（N）作为对照组；11例在临床改善后（3.4±3.8个月）接受检查；11例在病情恶化后（12±17）接受检查。我们评估了：左心室舒张末期内径（LVIDd）、壁厚/半径比（H/R）、舒张末期容积（D）和收缩末期容积（S Vol）、射血分数（EF）、收缩期动脉压/收缩末期容积比（P/V）以及应激。所有组的LVIDd和应激均增加；除HT和I级患者外，H/R降低；除I级患者外，EF和P/V降低。I级和II级之间LVIDd不同；II级和III级之间所有参数均不同，III级和IV级之间只有EF和P/V不同。根据回归分析S-D Vol、EF-P/V和EF-应激，我们确定了EF的降低及其相关机制，即收缩力降低或后负荷增加。因此，根据P/V和应激，我们将患者分为4种病理生理类型：1型和2型P/V在正常范围的2个标准差内：1型应激在正常范围的2个标准差内，EF和H/R正常；2型应激大于正2个标准差，H/R正常且EF降低；3型和4型P/C小于负2个标准差：3型正常，4型应激大于正2个标准差。在1型和2型中，14例中有1例为NYHA III级，无IV级；在3型中，8例中有6例为II级，在4型中，35例中有9例心功能分级低于III级。在随访中，8例病情改善的患者EF和P/V增加，应激降低；3例EF降低。8例病情恶化的患者EF和P/V降低，LVIDd和应激增加；3例EF和LVIDd增加，P/V降低。本研究表明NYHA分级与超声心动图结果不一致，且NYHA分级无法提供心力衰竭各组成部分的信息。然而，LVID和EF并不足够。通过对收缩力、后负荷和泵功能的超声心动图参数进行相关性分析，我们可以提出心力衰竭的病理生理类型分类。
