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清醒犬急性右心室高压时左心室三维动态几何形状及收缩功能的改变

Alterations in left ventricular three-dimensional dynamic geometry and systolic function during acute right ventricular hypertension in the conscious dog.

作者信息

Visner M C, Arentzen C E, O'Connor M J, Larson E V, Anderson R W

出版信息

Circulation. 1983 Feb;67(2):353-65. doi: 10.1161/01.cir.67.2.353.

DOI:10.1161/01.cir.67.2.353
PMID:6848225
Abstract

Fifteen chronically instrumented, conscious dogs were studied to determine whether, in the intact circulation, mechanical interactions dictated by the anatomic contiguity of the two ventricles significantly alter left ventricular (LV) dynamic geometry and systolic function during acute right ventricular (RV) hypertension. The three-dimensional geometry of the left ventricle was monitored with three pairs of ultrasonic dimension transducers; ventricular pressures were measured with micromanometers. Data collected during pulmonary artery constriction (RV pressure 68 +/- 8/7 +/- 4 mm Hg) were compared with control data collected at matched heart rates (RV pressure 32 +/- 8/4 +/- 4 mm Hg). During pulmonary artery constriction, mean calculated LV end-diastolic volumes decreased from 69.2 +/- 20.0 to 56.2 +/- 21.3 cm3 (p less than or equal to 0.05). Mean systolic stroke volume decreased from 20.6 +/- 5.5 to 14.0 +/- 6.3 cm3 (p less than or equal to 0.05). These changes were entirely accounted for by alterations in the behavior of the LV septal-free wall minor axis and rearrangements in LV equatorial geometry. When the pulmonary artery was constricted, elongation of the septal-free wall axis occurred during isovolumic systole and was accompanied by a reciprocal decrease in anterior-posterior dimension. Most of the decrease in septal-free wall dimension occurred during relaxation and early diastole rather than during ejection. Mean septal-free wall end-diastolic dimension decreased from 5.45 +/- 0.69 to 4.90 +/- 0.75 cm (p less than or equal to 0.05). The mean systolic decrease in septal-free wall dimension fell from 0.36 +/- 0.18 to 0.14 +/- 0.22 cm (p less than or equal to 0.05). The end-diastolic dimensions and systolic shortening of the LV anterior-posterior minor axis and base-apex major axis were not significantly altered by pulmonary artery constriction. These findings suggest that during acute RV hypertension, impairment of LV systolic function and rearrangements in LV dynamic geometry are primarily the result of the anatomic contiguity of the two ventricles.

摘要

对15只长期植入仪器的清醒犬进行研究,以确定在完整循环中,两个心室的解剖相邻性所决定的机械相互作用是否会在急性右心室(RV)高血压期间显著改变左心室(LV)的动态几何形状和收缩功能。用三对超声尺寸换能器监测左心室的三维几何形状;用微测压计测量心室压力。将肺动脉收缩期间(右心室压力68±8/7±4毫米汞柱)收集的数据与在匹配心率下(右心室压力32±8/4±4毫米汞柱)收集的对照数据进行比较。在肺动脉收缩期间,计算得出的左心室舒张末期平均容积从69.2±20.0立方厘米降至56.2±21.3立方厘米(p≤0.05)。平均收缩期搏出量从20.6±5.5立方厘米降至14.0±6.3立方厘米(p≤0.05)。这些变化完全是由左心室室间隔-游离壁短轴行为的改变和左心室赤道几何形状的重新排列所导致的。当肺动脉收缩时,室间隔-游离壁轴在等容收缩期发生伸长,并伴有前后径的相应减小。室间隔-游离壁尺寸的大部分减小发生在舒张期和舒张早期,而非射血期。室间隔-游离壁舒张末期平均尺寸从5.45±0.69厘米降至4.90±0.75厘米(p≤0.05)。室间隔-游离壁尺寸的平均收缩期减小从0.36±0.18厘米降至0.14±0.22厘米(p≤0.05)。肺动脉收缩对左心室前后短轴和心底-心尖长轴的舒张末期尺寸和收缩期缩短无显著影响。这些发现表明,在急性右心室高血压期间,左心室收缩功能受损和左心室动态几何形状的重新排列主要是两个心室解剖相邻性的结果。

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