Garrahy P J, Kwan O L, Booth D C, DeMaria A N
Division of Cardiovascular Medicine, University of Kentucky Medical Center, Lexington 40535.
Circulation. 1990 Jul;82(1):95-104. doi: 10.1161/01.cir.82.1.95.
Few data exist regarding the consequences of abnormalities of segmental contraction on intraventricular flow patterns. The development of color Doppler flow imaging has now permitted the visualization of intraventricular blood flow patterns. Therefore, we performed Doppler flow mapping in 41 patients (12 with normal left ventricular contraction, eight with hypokinesis or akinesis, and 21 with dyskinesis) and compared these findings with left ventriculography. Systolic blood flow by Doppler mapping in subjects with normal ventricular contraction was characterized primarily by flow through the left ventricular outflow tract and into the aorta. In patients with dyskinesis, paradoxical systolic flow toward the abnormal segment was present, and persisted for at least 50% of systole in 18 of 21 patients. Mean duration of paradoxical flow in dyskinetic patients was 77% of systole. Paradoxical flow was also observed in two of five patients with akinesis but in no patients with hypokinesis. A good correlation was observed between the duration of paradoxical systolic flow and indexes of regional wall motion (radian shortening of the involved myocardium) (r = 0.77) and global ejection fraction derived from cineangiography (r = 0.79). Correlations between the area of the paradoxical systolic flow stream in midsystole and indexes of left ventricular function were less close, with r equaling 0.57 for both regional wall motion and ejection fraction. Thus, paradoxical systolic flow can be detected in most patients with left ventricular dyskinesis, and correlates with the magnitude of regional and global left ventricular dysfunction by cineangiography.
关于节段性收缩异常对心室内血流模式的影响，现有数据较少。彩色多普勒血流成像技术的发展现已使心室内血流模式可视化成为可能。因此，我们对41例患者（12例左心室收缩正常、8例运动减弱或运动不能、21例运动障碍）进行了多普勒血流测绘，并将这些结果与左心室造影结果进行比较。正常心室收缩患者通过多普勒测绘得到的收缩期血流主要表现为经左心室流出道进入主动脉的血流。运动障碍患者出现了向异常节段的矛盾性收缩期血流，21例患者中有18例这种血流至少持续了收缩期的50%。运动障碍患者矛盾性血流的平均持续时间为收缩期的77%。在5例运动不能患者中有2例也观察到了矛盾性血流，但运动减弱患者中未观察到。矛盾性收缩期血流的持续时间与局部室壁运动指标（受累心肌的弧度缩短）（r = 0.77）以及电影血管造影得出的整体射血分数（r = 0.79）之间存在良好的相关性。收缩中期矛盾性收缩期血流束的面积与左心室功能指标之间的相关性不太密切，局部室壁运动和射血分数的r值均为0.57。因此，大多数左心室运动障碍患者可检测到矛盾性收缩期血流，且其与电影血管造影显示的局部和整体左心室功能障碍程度相关。
