Ranganathan N, Sivaciyan V
Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada.
Am J Cardiol. 1989 Mar 15;63(11):719-24. doi: 10.1016/0002-9149(89)90258-0.
Doppler recordings of jugular venous flow velocity previously performed in this laboratory in patients with pulmonary hypertension had shown variations from the normal dominant systolic flow (SF) greater than diastolic flow (DF), to SF = DF, SF less than DF or DF alone. The mechanisms underlying these flow alterations were studied in 25 patients and correlated with hemodynamics. The patients with abnormal flow patterns had increased right atrial V-wave pressures. This was associated with an increased right ventricular early diastolic pressure. The incidence of clinical heart failure was higher in patients with SF less than DF or DF alone (8 of 11) compared with 5 of 10 patients with SF = DF. Thus, in patients with pulmonary hypertension, the abnormal jugular venous flow patterns appear to be caused by both an increased DF velocity and a decrease in SF velocity. Because the right atrial V-wave pressures were similar in patients with both SF = DF and SF less than DF or DF alone and the incidence of heart failure was higher in the latter, the decrease in SF must be a later phenomenon. Serial observations confirmed this temporal sequence. The applicability of these observations to bedside evaluation of patients with pulmonary hypertension is emphasized.
此前在本实验室对肺动脉高压患者进行的颈静脉血流速度多普勒记录显示，其血流模式与正常情况相比存在多种变化，从正常的收缩期血流（SF）占主导且大于舒张期血流（DF），到SF = DF、SF小于DF或仅出现DF。对25例患者的这些血流改变的潜在机制进行了研究，并与血流动力学进行了关联分析。血流模式异常的患者右心房V波压力升高。这与右心室舒张早期压力升高相关。SF小于DF或仅出现DF的患者（11例中有8例）临床心力衰竭的发生率高于SF = DF的患者（10例中有5例）。因此，在肺动脉高压患者中，异常的颈静脉血流模式似乎是由DF速度增加和SF速度降低共同导致的。由于SF = DF的患者与SF小于DF或仅出现DF的患者右心房V波压力相似，且后者心力衰竭的发生率更高，所以SF的降低必定是后期现象。系列观察证实了这一先后顺序。强调了这些观察结果在肺动脉高压患者床边评估中的适用性。
