Jenni R, Ruffmann K, Vieli A, Anliker M, Krayenbuehl H P
Eur Heart J. 1985 May;6(5):391-8. doi: 10.1093/oxfordjournals.eurheartj.a061877.
The purpose of this study was to reassess left ventricular ejection dynamics in hypertrophic cardiomyopathy, to investigate whether a premature stoppage of ejection occurs, as previously reported, and whether reliable criteria for left ventricular outflow tract obstruction can be established by non-invasive evaluation of aortic flow patterns. In a group of 21 patients with hypertrophic cardiomyopathy, composed of 9 with the obstructive form (HOCM), 9 with the non-obstructive form (HNCM) and 3 with apical hypertrophy (HACM), instantaneous flow velocities across the ascending aorta were determined non-invasively with a 16-gated Doppler 2-D echo instrument. Ten normals served as controls. The 16 flow velocities were averaged over 8 heart beats and the relative volume flow rate was calculated by microprocessor analysis. Ejection time (i.e. flow time) derived from the flow curves was compared with the available ejection period as determined from the carotid pulse tracing. In normals, ejection time amounted to 94 +/- 3% of the available ejection period, in HOCM to 92 +/- 5% and in HNCM to 93 +/- 4% (no significant differences). In HACM, however, ejection time was reduced to 71 +/- 14% of the available ejection period. In contrast to HNCM, aortic flow in HOCM was characterized by an early peak followed by a plateau at a sizably lower flow level for the rest of systole. Flow time of an abnormally short duration was the hallmark of HACM. We conclude that in patients with hypertrophic cardiomyopathy, HOCM and HNCM can be distinguished by the shape of their volume flow curves. A premature stoppage of ejection is only found in patients with HACM.
本研究的目的是重新评估肥厚型心肌病患者的左心室射血动力学，调查是否如先前报道的那样存在射血过早停止的情况，以及能否通过对主动脉血流模式的无创评估来建立左心室流出道梗阻的可靠标准。在一组21例肥厚型心肌病患者中，包括9例梗阻型（HOCM）、9例非梗阻型（HNCM）和3例心尖肥厚型（HACM），使用16门控多普勒二维超声心动图仪对升主动脉的瞬时流速进行无创测定。10名正常人作为对照。将16个流速在8个心动周期内进行平均，并通过微处理器分析计算相对容积流率。将从血流曲线得出的射血时间（即血流时间）与根据颈动脉搏动描记图确定的可用射血期进行比较。在正常人中，射血时间占可用射血期的94±3%，在HOCM中为92±5%，在HNCM中为93±4%（无显著差异）。然而，在HACM中，射血时间缩短至可用射血期的71±14%。与HNCM相比，HOCM的主动脉血流特征是早期出现一个峰值，随后在整个收缩期的其余时间处于明显较低的血流水平的平台期。异常短持续时间的血流时间是HACM的特征。我们得出结论，在肥厚型心肌病患者中，HOCM和HNCM可通过其容积血流曲线的形状来区分。射血过早停止仅在HACM患者中发现。
