Herve C, Duval A M, Malak J, Meguira A, Brun P
Unité de Recherche U.2 de l'Institut National de la Santé et de Recherche Médicale, Hôpital Henri Mondor, Créteil, France.
J Am Coll Cardiol. 1990 Jun;15(7):1587-93. doi: 10.1016/0735-1097(90)92831-l.
M-mode echocardiography reveals an abrupt change between early and late left ventricular posterior wall kinetics during relaxation. No attempt has been previously made to relate this wall kinetic change and transmitral flow rate. In 25 normal subjects, 14 patients with dilated cardiomyopathy (Group 1) and 17 patients with hypertrophic cardiomyopathy (Group 2), M-mode echocardiographic studies were performed on the posterior wall and mitral valve. Transient values of mitral orifice area were calculated and transmitral flow velocities were recorded: area and velocity data yielded transmitral flow rates. Time intervals were determined from mitral opening to peak early area, velocity and flow rate and to posterior wall slope change. An additional group included five patients with a mitral prosthesis. The posterior wall slope change was present when part of the myocardial structures were almost akinetic or when mitral chordae tendineae were absent; slope change appeared as a regional phenomenon in the free wall. In the normal subjects, close values were found for the four time intervals. In the patients with dilated and hypertrophic cardiomyopathy, peak early velocity (95.7 +/- 16.7 and 146.2 +/- 31.4 ms, respectively), peak flow rate (84.7 +/- 18.2 and 137.4 +/- 29.5 ms) and time to slope change (91.4 +/- 18.6 and 133.6 +/- 32.7 ms) were significantly delayed (p less than 0.001) in comparison with peak area (56.6 +/- 9.5 and 84.3 +/- 22.5 ms). Slope change does not indicate the end of the early filling phase but, rather, its transition from acceleration to deceleration. Time to peak velocity or time to peak filling rate must be considered in a relaxation analysis.
M型超声心动图显示，在舒张期左心室后壁运动动力学的早期和晚期之间存在突然变化。此前尚未有人尝试将这种室壁运动变化与二尖瓣血流速率联系起来。对25名正常受试者、14名扩张型心肌病患者（第1组）和17名肥厚型心肌病患者（第2组）进行了后壁和二尖瓣的M型超声心动图研究。计算二尖瓣口面积的瞬时值并记录二尖瓣血流速度：面积和速度数据得出二尖瓣血流速率。确定从二尖瓣开放至早期面积峰值、速度峰值、血流速率峰值以及后壁斜率变化的时间间隔。另外一组包括5名安装了二尖瓣人工瓣膜的患者。当部分心肌结构几乎无运动或二尖瓣腱索缺失时，会出现后壁斜率变化；斜率变化在游离壁表现为一种局部现象。在正常受试者中，四个时间间隔的值相近。在扩张型和肥厚型心肌病患者中，与面积峰值（分别为56.6±9.5和84.3±22.5毫秒）相比，早期峰值速度（分别为95.7±16.7和146.2±31.4毫秒）、峰值血流速率（分别为84.7±18.2和137.4±29.5毫秒）以及斜率变化时间（分别为91.4±18.6和133.6±32.7毫秒）均显著延迟（p<0.001）。斜率变化并不表明早期充盈阶段的结束，而是表明其从加速到减速的转变。在舒张功能分析中必须考虑达到峰值速度的时间或达到峰值充盈率的时间。
