Pollick C
Can J Cardiol. 1985 Jan;1(1):33-4.
Though a generation has elapsed since the recognition of hypertrophic cardiomyopathy, controversy continues to rage regarding its pathophysiology. Central to the controversy is the mechanism and significance of the pressure gradient. Systolic anterior motion (SAM) of the mitral valve, as demonstrated by angiography and echocardiography, is accepted as the cause of the pressure gradient by some groups but not others. The latter authors suggest that: SAM is an incidental effect of vigorous contraction which is itself the cause of the pressure gradient and that the pressure gradient does not represent left ventricular outflow obstruction. These views are examined in light of recent studies that have assessed the temporal and quantitative relationship between SAM and the pressure gradient. It is concluded that SAM with early mitral septal contact is the cause of the pressure gradient, and represents true left ventricular outflow obstruction.
尽管自肥厚型心肌病被认识以来已经过去了一代人的时间，但关于其病理生理学的争议仍在激烈进行。争议的核心是压力梯度的机制和意义。二尖瓣收缩期前向运动（SAM），如血管造影和超声心动图所示，一些研究小组认为它是压力梯度的原因，而另一些小组则不这样认为。后一组作者认为：SAM是强烈收缩的附带效应，而强烈收缩本身才是压力梯度的原因，并且压力梯度并不代表左心室流出道梗阻。根据最近评估SAM与压力梯度之间的时间和定量关系的研究，对这些观点进行了审视。得出的结论是，伴有二尖瓣早期与室间隔接触的SAM是压力梯度的原因，并且代表真正的左心室流出道梗阻。
