Tarumi N, Iwasaka T, Takahashi N, Morita Y, Sugiura T, Tamura T, Sumimoto T, Nishiue T, Inada M
Second Department of Internal Medicine, Kansai Medical University, Osaka, Japan.
Coron Artery Dis. 1994 Jan;5(1):61-6. doi: 10.1097/00019501-199401000-00008.
Left ventricular diastolic dysfunction may occur after the onset of acute myocardial infarction. Left ventricular diastolic filling dynamics are related to many factors. To evaluate the influence of left ventricular filling pressure on Doppler-derived left ventricular diastolic flow profiles in patients with acute myocardial infarction, we studied serial changes in filling during the first 5 days after the onset of uncomplicated acute myocardial infarction.
The study population consisted of 14 patients with acute myocardial infarction and 15 normal subjects: Doppler echocardiographic studies (left ventricular transmitral inflow and outflow velocity patterns) were performed on admission, and on the third and fifth days after infarction. Hemodynamic parameters were measured simultaneously using Doppler echocardiography.
The E wave was lower, the A wave and A:E ratio were higher, deceleration half time and isometric relaxation time were prolonged, and peak left ventricular ejection flow velocity was lower in myocardial infarction patients than in normal subjects. The E wave and pulmonary capillary wedge pressure were positively correlated on the first and the third day (r = 0.77, P < 0.001, and r = 0.67, P < 0.01, respectively), but not on the fifth day. The E wave and isometric relaxation time were negatively correlated on the fifth day (r = -0.72, P < 0.01), but not on the first and third day.
Left ventricular filling pressure (preload) was an important mechanism for maintaining left ventricular filling during the first 3 days, but the relaxation of the ventricle began to play a dominant role on the fifth day.
急性心肌梗死后可能会发生左心室舒张功能障碍。左心室舒张期充盈动力学与多种因素有关。为了评估左心室充盈压对急性心肌梗死患者经多普勒得出的左心室舒张期血流频谱的影响，我们研究了单纯性急性心肌梗死发病后前5天内充盈情况的系列变化。
研究人群包括14例急性心肌梗死患者和15名正常受试者：入院时以及梗死后第3天和第5天进行了多普勒超声心动图检查（左心室二尖瓣流入和流出速度模式）。同时使用多普勒超声心动图测量血流动力学参数。
与正常受试者相比，心肌梗死患者的E波较低，A波和A:E比值较高，减速半衰期和等容舒张时间延长，左心室射血峰值流速较低。E波与肺毛细血管楔压在第1天和第3天呈正相关（分别为r = 0.77，P < 0.001和r = 0.67，P < 0.01），但在第5天不相关。E波与等容舒张时间在第5天呈负相关（r = -0.72，P < 0.01），但在第1天和第3天不相关。
左心室充盈压（前负荷）在最初3天是维持左心室充盈的重要机制，但在第5天心室舒张开始起主导作用。
