Marino P, Prioli A M, Destro G, LoSchiavo I, Golia G, Zardini P
Cardiology Division, University of Verona, Italy.
Am Heart J. 1994 Apr;127(4 Pt 1):886-98. doi: 10.1016/0002-8703(94)90558-4.
After instantaneous left atrial volume was defined as the net difference between the forward-flowing blood from the lungs and the blood flowing through the mitral valve, we constructed the left atrial volume curve by sampling the Doppler mitral valve and the right upper pulmonary vein velocity from an apical four-chamber view in eight normal subjects and 11 patients with heart disease. The instantaneous mitral valve flow was estimated as mitral valve velocity x annular area (derived from the same view), whereas the pulmonary venous flow was obtained as right upper pulmonary vein velocity x pulmonary vein area, where pulmonary vein area = mitral valve velocity integral x mitral valve area) divided by pulmonary vein velocity integral. The left atrial volume curve can then be derived as: [(instantaneous pulmonary venous flow - mitral valve flow) + left atrial volume assessed at end diastole by two-dimensional echocardiography]. Biplane angiographic left atrial volume curves, available in four of 11 patients, compared morphologically very closely with the noninvasive curves, whereas the correlation coefficient for maximum (end-systolic) and filling (maximum minus minimum) left atrial volumes obtained from the Doppler-derived curve and the corresponding two-dimensional echocardiographic estimates was 0.95 (p < 0.001, standard error of the estimate = 11.9 ml), the dispersion of the data increased with decreasing volumes. These data demonstrate that combined Doppler mitral valve and pulmonary vein velocities can be used to construct the left atrial volume curve in human beings. The approach described, besides providing a tool for further noninvasive evaluation of the left atrial function, offers the opportunity for relating the continuous pulmonary venous flow to the intermittent filling of the ventricle through the mitral orifice in diastole, underlining the complex role that the left atrial cavity plays in this process.
将左心房瞬时容积定义为来自肺部的前向血流与流经二尖瓣的血流之间的净差值后，我们通过在8名正常受试者和11名心脏病患者中从心尖四腔视图采样多普勒二尖瓣和右上肺静脉速度，构建了左心房容积曲线。瞬时二尖瓣血流估计为二尖瓣速度×瓣环面积（从同一视图得出），而肺静脉血流则通过右上肺静脉速度×肺静脉面积获得，其中肺静脉面积 = 二尖瓣速度积分×二尖瓣面积）除以肺静脉速度积分。然后可以得出左心房容积曲线为：[（瞬时肺静脉血流 - 二尖瓣血流）+ 通过二维超声心动图在舒张末期评估的左心房容积]。11名患者中有4名可获得双平面血管造影左心房容积曲线，其形态与无创曲线非常接近，而从多普勒衍生曲线和相应的二维超声心动图估计值获得的最大（收缩末期）和充盈（最大减去最小）左心房容积的相关系数为0.95（p < 0.001，估计标准误差 = 11.9 ml），数据的离散度随容积减小而增加。这些数据表明，结合多普勒二尖瓣和肺静脉速度可用于构建人体左心房容积曲线。所描述的方法除了为进一步无创评估左心房功能提供工具外，还提供了将持续的肺静脉血流与舒张期通过二尖瓣口间歇充盈心室相关联的机会，突出了左心房腔在这一过程中所起的复杂作用。
