Eusebio J, Louie E K, Edwards L C, Loeb H S, Scanlon P J
Division of Cardiology, Loyola University Medical Center, Maywood, IL 60153.
Am Heart J. 1994 Nov;128(5):941-7. doi: 10.1016/0002-8703(94)90593-2.
Ten patients with severe aortic regurgitation (AR) and early diastolic mitral closure demonstrated by M-mode echocardiography (group I) were compared to 10 age-matched patients with severe AR and normal timing of mitral closure to quantify the accompanying alterations in transmitral flow dynamics assessed by pulsed Doppler echocardiography. Transmitral filling period expressed as a fraction of the time available for diastolic filling was significantly shortened in group I patients relative to group II patients (0.50 +/- 0.10 vs 1.04 +/- 0.09, p < 0.001) because early mitral closure truncated transmitral filling and obliterated the atrial contribution to left ventricular filling. The rapid diastolic filling period normalized for the time available for diastolic filling was also shortened for group I patients relative to group II patients (0.49 +/- 0.11 vs 0.64 +/- 0.19; p < 0.05). Early mitral closure in group I patients was functionally incomplete because 9 of the 10 patients had diastolic mitral regurgitation, which was not detected in any patients in group II (p < 0.001). Thus the group I patients with early mitral closure and severe aortic regurgitation had truncated transmitral inflow and diastolic mitral regurgitation. These patients had higher pulmonary capillary wedge pressures (32 +/- 6 vs 11 +/- 9 mm Hg; p < 0.001) and more severe functional limitation (p < 0.001) than group II patients.
将10例经M型超声心动图显示有严重主动脉瓣反流（AR）及舒张早期二尖瓣关闭的患者（第一组）与10例年龄匹配、有严重AR且二尖瓣关闭时间正常的患者进行比较，以量化经脉冲多普勒超声心动图评估的二尖瓣血流动力学的伴随改变。相对于第二组患者，第一组患者中以舒张期充盈可用时间的分数表示的二尖瓣充盈期显著缩短（0.50±0.10对1.04±0.09，p<0.001），因为二尖瓣过早关闭截断了二尖瓣充盈并消除了心房对左心室充盈的贡献。相对于第二组患者，第一组患者中经舒张期充盈可用时间标准化的快速舒张期充盈期也缩短了（0.49±0.11对0.64±0.19；p<0.05）。第一组患者的二尖瓣过早关闭在功能上是不完全的，因为10例患者中有9例存在舒张期二尖瓣反流，而第二组患者中未检测到任何舒张期二尖瓣反流（p<0.001）。因此，有二尖瓣过早关闭和严重主动脉瓣反流的第一组患者有二尖瓣流入截断和舒张期二尖瓣反流。这些患者的肺毛细血管楔压高于第二组患者（32±6对11±9mmHg；p<0.001），且功能受限更严重（p<0.001）。
