Sholler G F, Colan S D, Sanders S P, Keane J F
Department of Cardiology, Children's Hospital, Boston, Massachusetts.
J Am Coll Cardiol. 1988 Aug;12(2):492-7. doi: 10.1016/0735-1097(88)90425-1.
Validation of a totally noninvasive method for estimating instantaneous left ventricular pressure and constructing a pressure waveform throughout ejection in patients with aortic stenosis is reported. In 20 patients (aged 8.75 +/- 10 years) with congenital aortic stenosis (measured peak left ventricular pressure 120 to 260 mm Hg; transvalvular gradient 18 to 165 mm Hg), transaortic valve continuous wave Doppler ultrasound, indirect carotid pulse tracing, peripheral blood pressure and measured left ventricular pressure were recorded simultaneously at cardiac catheterization. Data were entered into a microcomputer using a digitizing tablet and the instantaneous Doppler gradient was calculated and added to instantaneous aortic pressure, derived from the time-corrected and calibrated carotid pulse tracing, to estimate instantaneous left ventricular pressure. Estimated left ventricular pressure waveforms reproduced measured left ventricular pressure closely. The mean error at peak left ventricular pressure was 0.2 +/- 4.8 mm Hg (r = 0.98, p = 0.001). The average error throughout ejection was 0.9 +/- 5.1 mm Hg. The error of estimated pressure was not related to age or the severity of aortic stenosis. The Doppler peak instantaneous gradient was observed to correlate closely (r = 0.97, p = 0.001) with peak to peak gradient. With this technique, the left ventricular pressure waveform throughout ejection can be accurately estimated noninvasively in patients with aortic stenosis. This methodology enables determination of mean, total and instantaneous systolic left ventricular pressure.
本文报道了一种完全无创的方法，用于估计主动脉瓣狭窄患者的瞬时左心室压力，并在整个射血过程中构建压力波形。在20例先天性主动脉瓣狭窄患者（年龄8.75±10岁）中，测量的左心室峰值压力为120至260 mmHg；跨瓣压差为18至165 mmHg，在心脏导管检查时同时记录经主动脉瓣连续波多普勒超声、间接颈动脉脉搏描记、外周血压和测量的左心室压力。使用数字化仪将数据输入微型计算机，计算瞬时多普勒压差，并将其加到根据时间校正和校准的颈动脉脉搏描记得出的瞬时主动脉压力上，以估计瞬时左心室压力。估计的左心室压力波形与测量的左心室压力密切再现。左心室峰值压力的平均误差为0.2±4.8 mmHg（r = 0.98，p = 0.001）。整个射血过程中的平均误差为0.9±5.1 mmHg。估计压力的误差与年龄或主动脉瓣狭窄的严重程度无关。观察到多普勒峰值瞬时压差与峰峰值压差密切相关（r = 0.97，p = 0.001）。通过这种技术，可以在主动脉瓣狭窄患者中无创地准确估计整个射血过程中的左心室压力波形。这种方法能够确定左心室平均、总收缩期和瞬时收缩期压力。
