二维组织追踪技术评价左心房功能对二尖瓣血流速度模式假性正常化的作用。

Role of the left atrial function on the pseudonormalization of the transmitral flow velocity pattern evaluated by two-dimensional tissue tracking technique.

机构信息

The Division of Cardiology, Fujita Health University Second Hospital, 3-6-10 Otobashi, Nakagawa, Nagoya 454-8503, Japan.

出版信息

J Cardiol. 2013 May;61(5):365-71. doi: 10.1016/j.jjcc.2013.01.007. Epub 2013 Mar 27.

DOI:10.1016/j.jjcc.2013.01.007

PMID:23540976

Abstract

BACKGROUND

Mechanisms of the pseudonormalization (PN) of the transmitral flow (TMF) velocity pattern have been mainly attributed to left ventricular diastolic function.

PURPOSE

To assess the influence of left atrial (LA) function on the PN with two-dimensional tissue tracking technique.

METHODS

The subjects consisted of 21 healthy volunteers and 70 patients with various cardiac diseases. Images of one cardiac cycle in the apical four-chamber view were stored by the HIVISION 900 (Hitachi Medico, Chiba, Japan). The LA volume (LAV) loop was created using two-dimensional tissue tracking technique and LAV index (LAVI) at a given cardiac phase was calculated. A preload of 90mmHg was applied using a customized lower body positive pressure (LBPP) system. Patients were divided into the PN group (n=18) with their early diastolic TMF velocity (E) increased and late diastolic TMF velocity (A) decreased, and the non-(N)-PN group (n=52) with both E and A wave velocities increased by LBPP.

RESULTS

(1) During LBPP, the LAVImax in both the groups increased significantly. (2) In the N-PN group, the LAVIpass (p<0.001), LAVIact (p<0.01), and LAVItotal (p<0.0001) increased significantly. The dV/dts (p<0.0001) and dV/dtE (p<0.0001) increased significantly with an increase in the dV/dtA. On the other hand, there was no change in those parameters except LAVIpass (p<0.05) and dV/dtE (p<0.05) significantly increased in the PN group. (3) As a result, the LAVImin was significantly greater in the PN group than in the N-PN group (p<0.0001) during LBPP. The ratio of E velocity to early diastolic mitral annular velocity (E/E') during LBPP was significantly greater in the PN group than in the N-PN group (p<0.0001).

CONCLUSIONS

The lack of an increase in active LA emptying volume in response to an increase of preload leads to elevated LA pressure and the pseudonormalization of the TMF velocity pattern in patients with various cardiac diseases.

摘要

背景

二尖瓣血流（TMF）速度模式的假性正常化（PN）机制主要归因于左心室舒张功能。

目的

使用二维组织追踪技术评估左心房（LA）功能对 PN 的影响。

方法

研究对象包括 21 名健康志愿者和 70 名患有各种心脏病的患者。使用 HIVISION 900（日立医疗，千叶，日本）在心尖四腔视图中存储一个心动周期的图像。使用二维组织追踪技术创建 LA 容积（LAV）环，并计算给定心动周期的 LAVI。使用定制的下体正压（LBPP）系统施加 90mmHg 的前负荷。将患者分为 PN 组（n=18），其早期舒张 TMF 速度（E）增加，晚期舒张 TMF 速度（A）降低，以及非-PN 组（n=52），LBPP 使 E 和 A 波速度均增加。

结果

（1）在 LBPP 期间，两组的 LAVImax 均显着增加。（2）在 N-PN 组中，LAVIpass（p<0.001）、LAVIact（p<0.01）和 LAVItotal（p<0.0001）显着增加。dV/dts（p<0.0001）和 dV/dtE（p<0.0001）显着增加，而 dV/dtA 增加。另一方面，PN 组除 LAVIpass（p<0.05）和 dV/dtE（p<0.05）显着增加外，其他参数没有变化。（3）结果，在 LBPP 期间，PN 组的 LAVImin 显着大于 N-PN 组（p<0.0001）。PN 组的 E 速度与早期舒张二尖瓣环速度（E/E'）的比值在 LBPP 期间显着大于 N-PN 组（p<0.0001）。