Takagi S, Iwase M, Jing H X, Aoki T, Yokota M, Hayashi H, Sotobata I
First Department of Internal Medicine, Nagoya University School of Medicine.
J Cardiogr. 1986 Sep;16(3):637-47.
To investigate hemodynamic changes in ventricular premature contractions (VPCs), the blood flow velocities at the left ventricular (LV) outflow and inflow tracts were analyzed by pulsed Doppler echocardiography in 23 patients with VPCs and in two patients with ventricular parasystoles. Percent LV stroke volume of the ectopic and the postectopic sinus beats to the other sinus beats and %LV inflow volume of the sinus beats preceding ectopic beats to the other sinus beats were calculated from the time integral of the blood flow velocity. The following results were obtained. The %LV stroke volume of VPCs or %LV inflow volume of the preceding sinus beats correlated positively with the coupling interval of VPCs (r = 0.69, p less than 0.001 and r = 0.67, p less than 0.001, respectively). The %LV stroke volume of VPCs correlated positively with %LV inflow volume of the preceding sinus beats (r = 0.84, p less than 0.001). In some patients with VPCs of the RBBB pattern and in one patient with VPCs of the LBBB pattern associated with abnormal right axis deviation, the %LV stroke volume of VPC was much more reduced. In patients with depressed rapid filling and increased atrial filling, %LV stroke volume of the VPC or %LV inflow volume of the preceding sinus beat was smaller than in the other patients with the same coupling interval of VPCs. In VPCs of right ventricular (RV) origin, deterioration of RV hemodynamics was more prominent than in those of LV origin, and vice versa. Increased LV stroke volume was observed in postextrasystolic sinus beats, related to the coupling intervals of VPCs. However, the sum of %LV stroke volume of VPC and the postextrasystolic sinus beat decreased as the coupling intervals of VPC shortened. These results suggest that not only the coupling interval and the origin of VPCs but the LV diastolic behavior, as well, are important factors determining the hemodynamics in VPCs. They also suggest that the increment of stroke volume in postextrasystolic beats is more prominent in VPCs with shorter coupling intervals, but the LV performance as a whole is more depressed in VPCs with a shorter coupling intervals. In conclusion, pulsed Doppler echocardiography proved a useful noninvasive technique for evaluating the hemodynamics of VPCs.
为研究室性早搏（VPCs）时的血流动力学变化，采用脉冲多普勒超声心动图分析了23例室性早搏患者和2例室性并行心律患者左心室（LV）流出道和流入道的血流速度。根据血流速度的时间积分计算异位搏动和异位搏动后窦性搏动的左心室每搏量占其他窦性搏动的百分比，以及异位搏动前窦性搏动的左心室流入量占其他窦性搏动的百分比。结果如下：室性早搏的左心室每搏量百分比或早搏前窦性搏动的左心室流入量百分比与室性早搏的联律间期呈正相关（分别为r = 0.69，p < 0.001和r = 0.67，p < 0.001）。室性早搏的左心室每搏量百分比与早搏前窦性搏动的左心室流入量百分比呈正相关（r = 0.84，p < 0.001）。在一些右束支传导阻滞（RBBB）型室性早搏患者和1例伴有异常右轴偏移的左束支传导阻滞（LBBB）型室性早搏患者中，室性早搏的左心室每搏量百分比降低更为明显。在快速充盈降低和心房充盈增加的患者中，室性早搏的左心室每搏量百分比或早搏前窦性搏动的左心室流入量百分比低于具有相同室性早搏联律间期的其他患者。在右心室（RV）起源的室性早搏中，右心室血流动力学恶化比左心室起源的室性早搏更明显，反之亦然。在早搏后窦性搏动中观察到左心室每搏量增加，这与室性早搏的联律间期有关。然而，随着室性早搏联律间期缩短，室性早搏和早搏后窦性搏动的左心室每搏量百分比之和降低。这些结果表明，不仅室性早搏的联律间期和起源，而且左心室舒张功能也是决定室性早搏血流动力学的重要因素。它们还表明，在联律间期较短的室性早搏中，早搏后搏动的每搏量增加更为明显，但在联律间期较短的室性早搏中，左心室整体功能更受抑制。总之，脉冲多普勒超声心动图被证明是一种评估室性早搏血流动力学的有用无创技术。
