Hess O M, Ritter M, Schneider J, Grimm J, Turina M, Krayenbuehl H P
Circulation. 1984 May;69(5):855-65. doi: 10.1161/01.cir.69.5.855.
Passive diastolic properties were determined in 10 control patients and 21 patients with aortic valve disease before and 17.5 months after successful valve replacement. Ten patients had severe aortic stenoses (AS), five had combined aortic valve lesions (AS + aortic insufficiency [AI]), and six patients had severe AI. Left ventricular endomyocardial biopsies were obtained before and after surgery in patients with AS, AS + AI, and AI. Simultaneous echocardiographic and high-fidelity pressure measurements were made in all patients, and left ventricular chamber stiffness was calculated from a viscoelastic pressure-circumference relationship and left ventricular myocardial stiffness from a viscoelastic stress-strain relationship. The constant of chamber stiffness, beta', was slightly although not significantly increased in patients with AS (0.27 before and 0.24 after surgery), but was normal in those with AS + AI (0.22 before and 0.17 after surgery) and slightly decreased in those with AI (0.18 before and 0.16 after surgery) when compared with in control subjects (0.21). The constant of myocardial stiffness beta was normal in patients with AS (13.2), AS + AI (11.5), and AI (11.7) before surgery compared with in the control group (12.5). beta increased, however, significantly in those with AS (25.2; p less than .02), but not in those with AS + AI (16.3; NS) and AI (12.8; NS) after surgery. Myocardial morphologic characteristics showed a significant decrease in muscle fiber diameter in patients with AS, AS + AI, and AI, as well as a significant increase in interstitial fibrosis from 15% to 26% (p less than .05) in those with AS and a slight increase from 15% to 22% (NS) in those with AS + AI and from 19% to 24% (NS) in those with AI. Left ventricular fibrous content (left ventricular muscle mass index multiplied by interstitial fibrosis) remained, however, unchanged in all three groups after aortic valve replacement. In conclusion, left ventricular chamber stiffness is increased in AS but decreased in AI, whereas LV myocardial stiffness is normal in patients with aortic valve disease before surgery. After surgery, left ventricular myocardial stiffness increased significantly in AS patients but remained unchanged in those with AI. Postoperative changes in myocardial structure were characterized by a decrease in muscle fiber diameter and a relative increase in interstitial fibrosis, whereas fibrous content remained unchanged. Thus, regression of myocardial hypertrophy in aortic valve disease is accompanied by an increase of myocardial stiffness in concentric hypertrophy that is not seen in eccentric hypertrophy.
在10名对照患者以及21名主动脉瓣疾病患者成功进行瓣膜置换术前和术后17.5个月时，测定其被动舒张特性。10名患者患有严重主动脉瓣狭窄（AS），5名患者患有主动脉瓣联合病变（AS + 主动脉瓣关闭不全 [AI]），6名患者患有严重AI。对患有AS、AS + AI和AI的患者在手术前后进行左心室心内膜活检。对所有患者同时进行超声心动图和高保真压力测量，并根据粘弹性压力 - 周长关系计算左心室腔硬度，根据粘弹性应力 - 应变关系计算左心室心肌硬度。与对照受试者（0.21）相比，AS患者的腔硬度常数β'略有增加（术前0.27，术后0.24），但差异无统计学意义，而AS + AI患者（术前0.22，术后0.17）正常，AI患者（术前0.18，术后0.16）略有降低。与对照组（12.5）相比，术前AS患者（13.2）、AS + AI患者（11.5）和AI患者（11.7）的心肌硬度常数β正常。然而术后，AS患者的β显著增加（25.2；p < 0.02），而AS + AI患者（16.3；无统计学意义）和AI患者（12.8；无统计学意义）未增加。心肌形态学特征显示，AS、AS + AI和AI患者的肌纤维直径显著减小，AS患者的间质纤维化从15%显著增加至26%（p < 0.05），AS + AI患者从15%略有增加至22%（无统计学意义），AI患者从一19%至24%（无统计学意义）。然而，主动脉瓣置换术后，所有三组的左心室纤维含量（左心室肌肉质量指数乘以间质纤维化）均保持不变。总之，AS患者左心室腔硬度增加，而AI患者降低，主动脉瓣疾病患者术前左心室心肌硬度正常。术后，AS患者左心室心肌硬度显著增加，而AI患者保持不变。心肌结构的术后变化特征为肌纤维直径减小和间质纤维化相对增加，而纤维含量保持不变。因此，主动脉瓣疾病中心肌肥厚的消退伴随着同心性肥厚中心肌硬度的增加，而离心性肥厚中未见此现象。
