Floyd J, Willis P W, Craige E
Am J Cardiol. 1983 Jan 15;51(2):311-4. doi: 10.1016/s0002-9149(83)80056-3.
Simultaneously recorded phonocardiograms and apexcardiograms of 39 patients with mitral stenosis (MS) were retrospectively analyzed. A notch on the upstroke of the apexcardiogram coincidental with the first heart sound (S1) occurred in 18 (47%) of the patients. The notch ratio or vertical distance from the onset of the apical impulse to the notch ratio or vertical distance from the onset of the apical impulse to the notch as a percentage of the total upstroke was measured and compared with the mean mitral diastolic gradient obtained at cardiac catheterization. Statistical analysis showed a significant relation (r = 0.61; p less than 0.01) between notch ratio and the mean mitral diastolic gradient. This study reaffirms that the complex palpable movements at the cardiac apex, consisting of a "tap" representing S1 occurring perceptibly after the onset of the apex impulse itself, are a useful diagnostic sign of MS. Furthermore, a graphic measurement of the extent of delay of S1 with respect to the onset of the apical thrust can provide a rough measure of the severity of the valvular obstruction.
对39例二尖瓣狭窄（MS）患者同时记录的心音图和心尖搏动图进行了回顾性分析。心尖搏动图上升支上与第一心音（S1）同时出现的切迹在18例（47%）患者中出现。测量切迹比率或从心尖搏动开始到切迹的垂直距离占上升支总距离的百分比，并与心导管检查时获得的平均二尖瓣舒张期梯度进行比较。统计分析显示切迹比率与平均二尖瓣舒张期梯度之间存在显著相关性（r = 0.61；p < 0.01）。本研究再次证实，心尖处复杂的可触及运动，包括在心尖搏动开始后明显出现的代表S1的“喀喇音”，是MS的一个有用诊断体征。此外，对S1相对于心尖搏动开始的延迟程度进行图形测量，可以粗略衡量瓣膜阻塞的严重程度。
