Stoddard M F, Pearson A C, Kern M J, Ratcliff J, Mrosek D G, Labovitz A J
Department of Internal Medicine, St. Louis University School of Medicine, Missouri.
J Am Coll Cardiol. 1989 Feb;13(2):327-36. doi: 10.1016/0735-1097(89)90507-x.
To evaluate the influence of left ventricular chamber stiffness and relaxation on Doppler echocardiographic indexes of diastolic function, 35 patients (mean age 60 +/- 12 years) were examined; 24 had coronary artery disease and 11 (Group I) had no cardiovascular disease. Micromanometer left ventricular pressure was recorded simultaneously with Doppler echocardiograms of mitral valve inflow and M-mode echocardiograms of left ventricular diameter. The chamber stiffness constant (k) was derived from the pressure-diameter relation. Relaxation was assessed by the isovolumic relaxation time constant (tau) derived from the exponential left ventricular pressure decay. The patients with coronary artery disease were classified into two groups on the basis of complete (Group II; n = 10) and incomplete (Group III; n = 14) relaxation. In Group I (no coronary disease), significant correlations were demonstrated between the chamber stiffness constant and the peak early filling velocity (r = 0.73; p less than 0.02), peak early to atrial filling velocity ratio (r = 0.82; p less than 0.005), atrial time-velocity integral (r = -0.73; p less than 0.02), early to atrial time-velocity integral ratio (r = 0.70; p less than 0.05), percent atrial contribution to filling (r = -0.64; p less than 0.05) and one-half filling fraction (r = 0.73; p less than 0.02). In Group II (coronary disease with complete relaxation), the chamber stiffness constant correlated with peak early filling velocity (r = 0.68; p less than 0.05), early filling time-velocity integral (r = 0.65; p less than 0.05) and early to atrial time-velocity integral ratio (r = 0.74; p less than 0.02). No correlations between k and Doppler indexes were found in Group III (coronary disease with incomplete relaxation). However, Group III demonstrated significant correlations between tau and the peak early filling velocity (r = -0.71; p less than 0.005), percent atrial contribution to filling (r = 0.56; p less than 0.05) and mean acceleration rate of early filling (r = -0.79; p less than 0.002). Thus, in subjects with normal relaxation, increasing chamber stiffness was associated with an enhanced peak early filling velocity and volume and decreased filling during atrial systole. This finding differs strikingly from the proposed influence of chamber stiffness on diastolic filling postulated by several researchers.(ABSTRACT TRUNCATED AT 400 WORDS)
为评估左心室腔僵硬度和舒张功能对多普勒超声心动图舒张功能指标的影响，对35例患者（平均年龄60±12岁）进行了检查；其中24例患有冠状动脉疾病，11例（第一组）无心血管疾病。在记录二尖瓣血流多普勒超声心动图和左心室直径M型超声心动图的同时，记录微测压左心室压力。腔僵硬度常数（k）由压力-直径关系得出。通过从指数形式的左心室压力衰减得出的等容舒张时间常数（tau）评估舒张功能。根据舒张功能完全正常（第二组；n = 10）和不完全正常（第三组；n = 14），将冠状动脉疾病患者分为两组。在第一组（无冠状动脉疾病）中，腔僵硬度常数与早期充盈峰值速度（r = 0.73；p<0.02）、早期与心房充盈峰值速度比值（r = 0.82；p<0.005）、心房时间-速度积分（r = -0.73；p<0.02）、早期与心房时间-速度积分比值（r = 0.70；p<0.05）、心房充盈贡献率（r = -0.64；p<0.05）和半充盈分数（r = 0.73；p<0.02）之间存在显著相关性。在第二组（冠状动脉疾病且舒张功能完全正常）中，腔僵硬度常数与早期充盈峰值速度（r = 0.68；p<0.05）、早期充盈时间-速度积分（r = 0.65；p<0.05）和早期与心房时间-速度积分比值（r = 0.74；p<0.02）相关。在第三组（冠状动脉疾病且舒张功能不完全正常）中未发现k与多普勒指标之间存在相关性。然而，第三组显示tau与早期充盈峰值速度（r = -0.71；p<0.005）、心房充盈贡献率（r = 0.56；p<0.05）和早期充盈平均加速度（r = -0.79；p<0.002）之间存在显著相关性。因此，在舒张功能正常的受试者中，腔僵硬度增加与早期充盈峰值速度和容量增加以及心房收缩期充盈减少相关。这一发现与几位研究人员提出的腔僵硬度对舒张期充盈的影响显著不同。（摘要截短至400字）
