Stoddard M F, Vandormael M G, Pearson A C, Gudipati C, Kern M J, Deligonul U, Labovitz A J
Department of Internal Medicine, St. Louis University School of Medicine, Missouri.
J Am Coll Cardiol. 1989 Nov 1;14(5):1218-28. doi: 10.1016/0735-1097(89)90420-8.
The effect of aortic balloon valvuloplasty on left ventricular diastolic function and filling was investigated in 44 adult patients with severe aortic stenosis. Two-dimensional and Doppler echocardiography was performed in all patients before and 24 h after valvuloplasty. In 19 patients (short-term group) repeat studies were performed at 3 (n = 2) and 6 (n = 17) months. Left ventricular relaxation, chamber stiffness and filling were assessed in 16 patients (immediate post-valvuloplasty group) before and immediately after valvuloplasty by simultaneous micromanometer left ventricular pressure tracings and echocardiograms. Immediately after valvuloplasty, relaxation was slightly impaired in the immediate post-valvuloplasty group, as reflected by the isovolumic relaxation time constant (56 +/- 26 to 68 +/- 39 ms; p less than 0.01) and maximal negative dP/dt (2,063 +/- 640 to 1,767 +/- 495 mm Hg/s; p less than 0.001). The chamber stiffness constants and diastolic filling dynamics were unchanged immediately after valvuloplasty. Twenty-four hours after valvuloplasty, patients without mitral regurgitation (n = 24) showed increases in the peak early filling velocity (72 +/- 31 to 83 +/- 28 cm/s; p less than 0.05) and peak early to atrial filling velocity ratio (0.8 +/- 0.6 to 1.0 +/- 0.7; p less than 0.05). However, in patients with mitral regurgitation (n = 20), the diastolic filling dynamics were not significantly changed. In the short-term group at the 3 to 6 month follow-up period, patients without mitral regurgitation (n = 12) showed striking increases compared with pre-valvuloplasty values in the peak early filling velocity (66 +/- 21 to 93 +/- 31 cm/s; p less than 0.02), peak early to atrial filling velocity ratio (0.6 +/- 0.2 to 0.9 +/- 0.4; p less than 0.02) and early time-velocity integral (9 +/- 4 to 16 +/- 6 cm; p less than 0.002). In patients with mitral regurgitation (n = 7) decreases occurred in the peak early filling velocity (123 +/- 32 to 106 +/- 28 cm/s; p less than 0.05) and peak early to atrial filling velocity ratio (1.5 +/- 0.7 to 1.1 +/- 0.6; p less than 0.05). Functional class in hospital improved after valvuloplasty (3.1 +/- 1.0 to 2.6 +/- 0.9; p less than 0.001) and correlated modestly with the percent decrease in Doppler-derived peak gradient (rs = 0.41, p less than 0.02) and mean gradient (rs = 0.36, p less than 0.05), but did not correlate with changes in aortic valve area, left ventricular ejection fraction or diastolic filling variables.(ABSTRACT TRUNCATED AT 400 WORDS)
在44例重度主动脉瓣狭窄的成年患者中研究了主动脉球囊瓣膜成形术对左心室舒张功能和充盈的影响。所有患者在瓣膜成形术前及术后24小时均进行二维和多普勒超声心动图检查。19例患者（短期组）在术后3个月（n = 2）和6个月（n = 17）进行了重复检查。通过同步微测压左心室压力描记和超声心动图，在16例患者（瓣膜成形术后即刻组）瓣膜成形术前及术后即刻评估左心室舒张、腔室硬度和充盈情况。瓣膜成形术后即刻，瓣膜成形术后即刻组的舒张功能略有受损，等容舒张时间常数（56±26至68±39毫秒；p<0.01）和最大负dP/dt（2,063±640至1,767±495毫米汞柱/秒；p<0.001）反映了这一点。瓣膜成形术后即刻腔室硬度常数和舒张期充盈动力学未发生变化。瓣膜成形术后24小时，无二尖瓣反流的患者（n = 24）早期充盈峰值速度增加（72±31至83±28厘米/秒；p<0.05），早期与心房充盈峰值速度比值增加（0.8±0.6至1.0±0.7；p<0.05）。然而，有二尖瓣反流的患者（n = 20）舒张期充盈动力学无显著变化。在短期组3至6个月的随访期内，无二尖瓣反流的患者（n = 12）与瓣膜成形术前相比，早期充盈峰值速度（66±21至93±31厘米/秒；p<0.02）、早期与心房充盈峰值速度比值（0.6±0.2至0.9±0.4；p<0.02）和早期时间速度积分（9±4至16±6厘米；p<0.002）显著增加。有二尖瓣反流的患者（n = 7）早期充盈峰值速度（123±32至106±28厘米/秒；p<0.05）和早期与心房充盈峰值速度比值（1.5±0.7至1.1±0.6；p<0.05）下降。瓣膜成形术后患者的功能分级改善（3.1±1.0至2.6±0.9；p<0.001），与多普勒衍生峰值梯度的下降百分比（rs = 0.41，p<0.02）和平均梯度（rs = 0.36，p<0.05）呈适度相关，但与主动脉瓣面积、左心室射血分数或舒张期充盈变量的变化无关。（摘要截短至400字）
