Bittl J A, Bhatia S J, Plappert T, Ganz P, St John Sutton M G, Selwyn A P
Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts 02115.
J Am Coll Cardiol. 1989 Jul;14(1):135-42. doi: 10.1016/0735-1097(89)90063-6.
Peak left ventricular pressure during balloon inflation was measured in 20 patients who underwent balloon valvuloplasty for severe aortic stenosis to define the determinants of ventricular pressure development in response to increased loading conditions. The peak left ventricular pressure ranged from 150 +/- 5 to 386 +/- 22 mm Hg (mean +/- SD), was reproducible in each patient with each balloon inflation (mean coefficient of variation 7.8%) and correlated with concurrent echocardiographic measurements of ejection fraction (r = 0.89, p = 0.0001) and mass/volume ratio in systole (r = 0.91, p = 0.0001) or diastole (r = 0.88, p = 0.0001). Thirteen patients with class II or more severe congestive heart failure had lower values for peak left ventricular pressure than did those without failure (225 +/- 46 versus 305 +/- 45 mm Hg, p = 0.002), whereas no difference in rest left ventricular systolic pressure was seen between the two groups. The measurement of peak left ventricular pressure was inversely related to rest mean circumferential end-systolic wall stress (r = 0.52, p = 0.046). Thus, peak left ventricular systolic pressure measured during aortic valvuloplasty in humans correlates closely with traditional measures of left ventricular function. This measurement, which previously has been obtained only in experimental animal studies, is a simple and reproducible hemodynamic index that may provide new insights in studies of ventricular function and congestive heart failure in aortic stenosis.
对20例因严重主动脉瓣狭窄接受球囊瓣膜成形术的患者，测量了球囊扩张时的左心室压力峰值，以确定负荷增加时心室压力变化的决定因素。左心室压力峰值范围为150±5至386±22 mmHg（均值±标准差），每次球囊扩张时在每位患者中均可重复（平均变异系数7.8%），并与同时进行的超声心动图测量的射血分数（r = 0.89，p = 0.0001）以及收缩期（r = 0.91，p = 0.0001）或舒张期（r = 0.88，p = 0.0001）的质量/容积比相关。13例II级或更严重充血性心力衰竭患者的左心室压力峰值低于无心力衰竭患者（225±46 vs 305±45 mmHg，p = 0.002），而两组静息左心室收缩压无差异。左心室压力峰值测量值与静息平均圆周收缩末期壁应力呈负相关（r = 0.52，p = 0.046）。因此，人类主动脉瓣成形术期间测量的左心室收缩压峰值与左心室功能的传统测量指标密切相关。该测量指标此前仅在实验动物研究中获得，是一个简单且可重复的血流动力学指标，可能为主动脉瓣狭窄患者的心室功能和充血性心力衰竭研究提供新的见解。
