Keren G, Bier A, Strom J A, Laniado S, Sonnenblick E H, LeJemtel T H
Am Heart J. 1986 Sep;112(3):517-25. doi: 10.1016/0002-8703(86)90516-8.
Seven patients with decompensated chronic heart failure and functional mitral regurgitation were studied before and during administration of nitroglycerin at a mean dose of 42 micrograms/min (range 20 to 90 micrograms/min). Forward aortic flow obtained by pulsed Doppler increased significantly from 35 +/- 8 to 45 +/- 9 ml/beat (p less than 0.001) and correlated well with the cardiac output measured by thermodilution technique (r = 0.8). Whereas regurgitant mitral volume calculated from the difference between echocardiographic total stroke volume and forward aortic flow decreased significantly from 19 +/- 9 to 3 +/- 3 ml/beat (p less than 0.001), peak velocity of mitral regurgitant flow increased from 4.1 +/- 0.9 to 4.4 +/- 1.0 m/sec (p less than 0.05). The decrease in effective mitral regurgitation area derived from a modified Gorlin formula average 80%. Accordingly, in patients with decompensated chronic heart failure and functional mitral regurgitation, nitroglycerin decreases mitral regurgitant area substantially, and thus almost abolishes mitral regurgitation despite an increase in systolic pressure gradient between left ventricle and atrium. Moreover, the increase in forward flow can be entirely accounted for by the reduction in mitral regurgitant flow.
对7例失代偿性慢性心力衰竭合并功能性二尖瓣反流患者在平均剂量为42微克/分钟（范围为20至90微克/分钟）的硝酸甘油给药前和给药期间进行了研究。通过脉冲多普勒获得的主动脉前向血流从35±8显著增加至45±9毫升/搏（p<0.001），且与通过热稀释技术测量的心输出量相关性良好（r=0.8）。根据超声心动图总搏出量与主动脉前向血流的差值计算出的二尖瓣反流容积从19±9显著降低至3±3毫升/搏（p<0.001），而二尖瓣反流峰值流速从4.1±0.9增加至4.4±1.0米/秒（p<0.05）。根据改良的戈林公式得出的有效二尖瓣反流面积平均减少80%。因此，在失代偿性慢性心力衰竭合并功能性二尖瓣反流患者中，硝酸甘油可显著降低二尖瓣反流面积，从而几乎消除二尖瓣反流，尽管左心室与心房之间的收缩压梯度增加。此外，前向血流的增加完全可由二尖瓣反流的减少来解释。
