Kass D A, Midei M, Graves W, Brinker J A, Maughan W L
Johns Hopkins Medical Institutions, Department of Medicine, Baltimore, MD.
Cathet Cardiovasc Diagn. 1988;15(3):192-202. doi: 10.1002/ccd.1810150314.
Determination of left ventricular pressure-volume relationships in situ ideally requires both a method for easy measurement of multiple pressure-volume loops and a rapid and reversible means of altering load. We report a technique, previously used in animals, that combines conductance catheter volumes and rapid inferior vena caval occlusion to permit routine measurement of calibrated P-V relationships in man for the first time. An 8F volume catheter with a 3F micromanometer tipped pressure catheter placed through its lumen was advanced to the left ventricular apex through a femoral artery. A thermodilution output catheter was placed through a 9F femoral venous sheath and later replaced with an IVC balloon occlusion catheter, through which a 2.5F bipolar wire was advanced for atrial pacing. A specialized data system facilitated collection, editing, and data analysis at the time of cardiac catheterization. Absolute volume calibration required cardiac output measurement and injection of hypertonic saline. IVC occlusion decreased peak left ventricular pressure by 42 +/- 17 (SD) (P less than .001) mm Hg in 15 patients. Endsystolic pressure-volume relationships (ESPVR) were determined with 5-8 cardiac cycles with an average of r2 of 0.94 +/- 0.05 and were generally reproducible. The slope of the ESPVR demonstrated consistency among a group of normal patients (n = 6), and was significantly lower than the slope derived from a group of patients with ventricular hypertrophy (n = 9). We conclude that left ventricular pressure-volume relationships can be easily and repeatedly determined as part of a routine cardiac catheterization in man.
理想情况下，要在原位测定左心室压力-容积关系，既需要一种便于测量多个压力-容积环的方法，也需要一种快速且可逆的改变负荷的手段。我们报告了一种先前用于动物的技术，该技术结合了电导导管容积测量和下腔静脉快速闭塞，从而首次能够在人体中常规测量校准后的压力-容积关系。将一根带有通过其管腔放置的3F微测压头压力导管的8F容积导管经股动脉推进至左心室心尖。将一根热稀释输出导管经9F股静脉鞘置入，随后换成下腔静脉球囊闭塞导管，通过该导管推进一根2.5F双极导线用于心房起搏。一种专门的数据系统便于在心脏导管插入术时进行数据收集、编辑和分析。绝对容积校准需要测量心输出量并注射高渗盐水。在15例患者中，下腔静脉闭塞使左心室峰值压力降低了42±17（标准差）（P＜0.001）mmHg。通过5至8个心动周期确定收缩末期压力-容积关系（ESPVR），平均r2为0.94±0.05，且通常具有可重复性。一组正常患者（n = 6）的ESPVR斜率表现出一致性，且显著低于一组心室肥厚患者（n = 9）得出的斜率。我们得出结论，作为人体常规心脏导管插入术的一部分，可以轻松且重复地测定左心室压力-容积关系。
