Klepzig H, Skupin M, Mildenberger D, Standke R, Satter P, Hör G, Kaltenbach M
Abteilung für Kardiologie, Klinikums der Johann-Wolfgang-Goethe-Universität Frankfurt/Main.
Z Kardiol. 1987 Nov;76(11):688-98.
The range of appropriate left ventricular dilatation due to volume overload was defined in 21 patients with a stable course of chronic aortic regurgitation, by correlating the scintigraphically determined left ventricular end-diastolic volume with the regurgitated blood volume. 25 other patients with chronic aortic regurgitation, who were scheduled for valve replacement, were within this normal range (group 1); in nine patients, left ventricular end-diastolic volume exceeded the amount expected from the amount of regurgitation (group 2). Patients were followed up between 2 and 62 months postoperatively (average: 26 +/- 13 months). No patients from group 1, but four out of nine patients from group 2 (45%) died postoperatively from congestive heart failure. In 23 out of 24 patients from group 1, left ventricular ejection fraction was postoperatively within the normal range, although preoperative values had been severely depressed in three cases (lower than 40%). Ejection fraction remained depressed in one patient with persistent mitral regurgitation and in all patients from group 2. Global heart volume significantly decreased by 20% in group 1, whereas only minor changes (-15%) were observed in group 2 (group 1: from 1184 +/- 186 to 954 +/- 120 ml, 2p less than 0.001; group 2: from 1402 +/- 300 to 1185 +/- 294 ml). This was compared to the course of left ventricular end-diastolic diameter (group 1: from 7.1 +/- 0.9 to 5.5 +/- 0.7 cm (-23%), 2p less than 0.001; group 2: from 7.6 +/- 0.7 to 6.9 +/- 1.3 cm (-9%). In group 1, left ventricular ejection fraction significantly increased, whereas no significant changes were observed in group 2 (group 1: from 53 +/- 13 to 64 +/- 13% (+21%), 2p less than 0.001; group 2: from 29 +/- 7 to 32 +/- 14% (+10%]. It is concluded that the scintigraphically determined ratio of left ventricular end-diastolic volume to regurgitated blood volume provides important prognostic and functional information regarding the postoperative course of chronic aortic regurgitation. This ratio is more reliable than single radionuclide, electrocardiographic, roentgenographic or echocardiographic parameters.
通过将闪烁扫描法测定的左心室舒张末期容积与反流血量相关联，确定了21例慢性主动脉瓣反流病程稳定患者因容量负荷过重导致的适宜左心室扩张范围。另外25例计划进行瓣膜置换的慢性主动脉瓣反流患者处于该正常范围内（第1组）；9例患者的左心室舒张末期容积超过了根据反流量预期的数值（第2组）。患者术后随访2至62个月（平均：26±13个月）。第1组无患者死亡，但第2组9例患者中有4例（45%）术后死于充血性心力衰竭。第1组24例患者中有23例术后左心室射血分数在正常范围内，尽管3例患者术前数值严重降低（低于40%）。1例持续性二尖瓣反流患者和第2组所有患者的射血分数仍降低。第1组全心容积显著减少20%，而第2组仅观察到轻微变化（-15%）（第1组：从1184±186降至954±120 ml，P<0.001；第2组：从1402±300降至1185±294 ml）。将此与左心室舒张末期直径的变化过程进行比较（第1组：从7.1±0.9降至5.5±0.7 cm（-23%），P<0.001；第2组：从7.6±0.7降至6.9±1.3 cm（-9%））。第1组左心室射血分数显著增加，而第2组未观察到显著变化（第1组：从53±13增至64±13%（+21%），P<0.001；第2组：从29±7增至32±14%（+10%））。结论是，闪烁扫描法测定的左心室舒张末期容积与反流血量之比为慢性主动脉瓣反流的术后病程提供了重要的预后和功能信息。该比值比单一的放射性核素、心电图、X线或超声心动图参数更可靠。
