Faggiano P, Rusconi C, Sabatini T, Ghizzoni G, Sorgato A, Gardini A
Divisione di Cardiologia, Ospedale S. Orsola-Fatebenefratelli, Brescia, Italia.
Cardiology. 1995;86(2):120-9. doi: 10.1159/000176853.
The aim of this study was to evaluate echographically anatomic and functional features of the left ventricle in adult patients with valvular aortic stenosis according to the presence or absence of congestive heart failure and the level of ventricular performance. Fifty-six adult patients with moderate-to-severe aortic stenosis underwent echocardiographic Doppler examination in order to evaluate left ventricular mass and dimensions, systolic function and filling dynamics. Twenty-seven patients had no heart failure and were symptomatic for angina (5), syncope (4) or were symptom-free (group I); the other 29 had heart failure (group II): 16 with normal left ventricular systolic performance (fractional shortening > 25%, group IIa) and 13 with systolic dysfunction (fractional shortening < or = 25%, group IIb). Despite a similar left ventricular mass, compared to group IIa, group IIb showed a significant left ventricular dilatation (end-diastolic diameter: 61 +/- 6.5 vs. 45.5 +/- 6.1 mm, p < 0.001) and mild or no increase in wall thickness (11.5 +/- 1.6 vs. 14.9 +/- 2 mm, p < 0.001). Indices of left ventricular filling on Doppler transmitral flow were also significantly different between the two groups, with a higher early-to-late filling ratio and a shorter deceleration time of early filling in group IIb (2.8 +/- 1.9 vs. 1.2 +/- 0.85, p < 0.01, and 122 +/- 66 vs. 190 +/- 87 ms, p < 0.05, respectively), both indirectly indicating higher left atrial pressure. Finally, heart failure was generally more severe in group IIb patients. In some patients with aortic stenosis, symptoms of heart failure may be present despite a normal left ventricular systolic function and seem to depend on abnormalities of diastolic function. The presence of systolic or isolated diastolic dysfunction appears to be related to a different geometric adaptation of the left ventricle to chronic pressure overload.
本研究旨在根据充血性心力衰竭的有无及心室功能水平，通过超声心动图评估成人主动脉瓣狭窄患者左心室的解剖和功能特征。56例中重度主动脉瓣狭窄的成年患者接受了超声心动图多普勒检查，以评估左心室质量和尺寸、收缩功能及充盈动力学。27例患者无心力衰竭，表现为心绞痛（5例）、晕厥（4例）或无症状（I组）；另外29例有心力衰竭（II组）：16例左心室收缩功能正常（缩短分数>25%，IIa组），13例有收缩功能障碍（缩短分数≤25%，IIb组）。尽管左心室质量相似，但与IIa组相比，IIb组左心室明显扩张（舒张末期直径：61±6.5 vs. 45.5±6.1 mm，p<0.001），且壁厚轻度增加或未增加（11.5±1.6 vs. 14.9±2 mm，p<0.001）。两组间二尖瓣血流多普勒的左心室充盈指标也有显著差异，IIb组早期与晚期充盈率更高，早期充盈减速时间更短（分别为2.8±1.9 vs. 1.2±0.85，p<0.01；122±66 vs. 190±87 ms，p<0.05），两者均间接提示左心房压力更高。最后，IIb组患者心力衰竭通常更严重。在一些主动脉瓣狭窄患者中，尽管左心室收缩功能正常，但仍可能出现心力衰竭症状，且似乎取决于舒张功能异常。收缩功能障碍或单纯舒张功能障碍的存在似乎与左心室对慢性压力超负荷的不同几何适应性有关。
