Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan.
Sci Rep. 2017 May 17;7(1):2037. doi: 10.1038/s41598-017-02247-5.
The effects of left ventricular (LV) cavity size on cardiac function and overload have not yet been fully elucidated. We performed a covariance structure analysis and drew theoretical path models to clarify the effects of hemodynamic parameters on the stroke volume index (SVI) as a marker of cardiac function and on the plasma B-type natriuretic peptide (BNP) level as a marker of cardiac overload. We simultaneously measured various hemodynamic parameters and the BNP levels during cardiac catheterization in 1,715 inpatients of our institution. The current path models tested the validity of the Frank-Starling law in patients with heart failure using the SVI, the LV end-systolic volume index (LVESVI) and the LV end-diastolic volume index (LVEDVI). Using the BNP levels, the path models clearly demonstrated that LVESVI substantially augmented cardiac overload, whereas LVEDVI palliated this parameter. These volume indices exerted opposite effects on cardiac function and overload. These results advance the understanding of the relationships between LV cavity size and both cardiac function and overload and indicate the increasing importance of LV diastolic volume in heart failure and the utility of LVESVI as an important marker of cardiac remodeling for further relevant studies.
左心室（LV）腔大小对心功能和负荷的影响尚未完全阐明。我们进行协方差结构分析并绘制理论路径模型，以阐明血流动力学参数对作为心功能标志物的每搏输出量指数（SVI）以及作为心功能过载标志物的血浆 B 型利钠肽（BNP）水平的影响。我们在机构的 1715 名住院患者进行心脏导管插入术的同时测量了各种血流动力学参数和 BNP 水平。当前的路径模型使用 SVI、LV 收缩末期容积指数（LVESVI）和 LV 舒张末期容积指数（LVEDVI）测试心力衰竭患者中 Frank-Starling 定律的有效性。使用 BNP 水平，路径模型清楚地表明，LVESVI 显著增加了心脏负荷，而 LVEDVI 减轻了该参数。这些容积指数对心功能和负荷产生相反的影响。这些结果增进了对 LV 腔大小与心功能和负荷之间关系的理解，并表明 LV 舒张容积在心力衰竭中的重要性日益增加，以及 LVESVI 作为心脏重构的重要标志物在进一步相关研究中的实用性。
