Kurokawa S, Takahashi M, Kato Y, Muramatsu J, Kikawada R
Department of Internal Medicine, Kitasato University School of Medicine, Sagamihara.
J Cardiol. 1988 Sep;18(3):823-36.
Using pulsed Doppler echocardiography, left ventricular inflow flow volume (LVIV) and outflow flow volume (LVOV) were noninvasively determined, and the ratio of pulmonary to systemic flow (Qp/Qs) was evaluated as the ratio of LVIV to LVOV (LVIV/LVOV). Thirty patients with ventricular septal defect (VSD) were studied, and 47 cardiac patients without aortic or mitral valve disease or intracardiac shunt served as controls. LVOV was derived from the left ventricular ejection flow velocity and the outflow tract diameter immediately proximal to the aortic valve ring. LVIV was derived from the transmitral flow velocity and the M-mode tracing of mitral valve motion. Doppler-determined cardiac outputs (COin and COout) were calculated as the products of LVIV or LVOV as and heart rates. Cardiac outputs were also determined by the dye dilution method (COdye) references for comparison with Doppler-determined cardiac outputs. There were good correlations between COdye and COin (y = 1.18x-243, r = 0.85, p less than 0.005, SEE = 1026 ml/min) and between COdye and COout (y = 1.16x-323, r = 0.90, p less than 0.005, SEE = 639 ml/min). LVIV and LVOV correlated well in the controls (y = 0.95x + 5.3, r = 0.94, p less than 0.005, SEE = 6.6 ml). LVIV/LVOV was 0.97 +/- 0.1 (mean +/- SD) in the controls; whereas LVIV/LVOV (1.86 +/- 0.90) was significantly higher in patients with VSD (p less than 0.01) and this ratio correlated well with Qp/Qs by an oximetry (r = 0.98, SEE = 0.20, n = 14), including patients associated with pulmonary regurgitation. These findings indicate that our method permits determination of LVIV with a high degree of accuracy and that the Doppler-determined LVIV/LVOV is clinically useful to evaluate accurately the magnitude of shunt flows in patients with VSD.
采用脉冲多普勒超声心动图，无创测定左心室流入量（LVIV）和流出量（LVOV），并将肺循环与体循环血流量之比（Qp/Qs）评估为LVIV与LVOV之比（LVIV/LVOV）。研究了30例室间隔缺损（VSD）患者，47例无主动脉或二尖瓣疾病或心内分流的心脏病患者作为对照。LVOV由左心室射血流速和紧邻主动脉瓣环的流出道直径得出。LVIV由二尖瓣血流速度和二尖瓣运动的M型描记图得出。通过将LVIV或LVOV与心率相乘计算出多普勒测定的心输出量（COin和COout）。心输出量也通过染料稀释法（COdye）测定，作为与多普勒测定的心输出量比较的参考。COdye与COin之间（y = 1.18x - 243，r = 0.85，p < 0.005，SEE = 1026 ml/min）以及COdye与COout之间（y = 1.16x - 323，r = 0.90，p < 0.005，SEE = 639 ml/min）存在良好的相关性。在对照组中，LVIV与LVOV相关性良好（y = 0.95x + 5.3，r = 0.94，p < 0.005，SEE = 6.6 ml）。对照组中LVIV/LVOV为0.97±0.1（平均值±标准差）；而VSD患者的LVIV/LVOV（1.86±0.90）显著更高（p < 0.01），并且该比值与通过血氧测定法得出的Qp/Qs相关性良好（r = 0.98，SEE = 0.20，n = 14），包括合并肺动脉反流的患者。这些发现表明我们的方法能够高度准确地测定LVIV，并且多普勒测定的LVIV/LVOV在临床上对于准确评估VSD患者的分流流量大小是有用的。
