Appleton C P, Galloway J M, Gonzalez M S, Gaballa M, Basnight M A
Cardiology Section, Veterans Affairs Medical Center, Tuscon, Arizona 85723.
J Am Coll Cardiol. 1993 Dec;22(7):1972-82. doi: 10.1016/0735-1097(93)90787-2.
The purpose of this study was to determine whether left atrial size and ejection fraction are related to left ventricular filling pressures in patients with coronary artery disease.
In patients with coronary artery disease, left ventricular filling pressures can be estimated by using Doppler mitral and pulmonary venous flow velocity variables. However, because these flow velocities are age dependent, additional variables that indicate elevated left ventricular filling pressures are needed to increase diagnostic accuracy.
Echocardiographic left atrial and Doppler mitral and pulmonary venous flow velocity variables were correlated with left ventricular filling pressures in 70 patients undergoing cardiac catheterization.
Left atrial size and volumes were larger and left atrial ejection fractions were lower in patients with elevated left ventricular filling pressures. Mean pulmonary wedge pressure was related to mitral E/A wave velocity ratio (r = 0.72), left atrial minimal volume (r = 0.70), left atrial ejection fraction (r = -0.66) and atrial filling fraction (r = -0.66). Left ventricular end-diastolic and A wave pressures were related to the difference in pulmonary venous and mitral A wave duration (both r = 0.77). By stepwise multilinear regression analysis, the ratio of mitral E to A wave velocity was the most important determinant of pulmonary wedge (r = 0.63) and left ventricular pre-A wave (r = 0.75) pressures, whereas the difference in pulmonary venous and mitral A wave duration was the most important variable for both left ventricular A wave (r = 0.75) and left ventricular end-diastolic (r = 0.80) pressures. The sensitivity of a left atrial minimal volume > 40 cm3 for identifying a mean pulmonary wedge pressure > 12 mm Hg was 82%, with a specificity of 98%.
Left atrial size, left atrial ejection fraction and the difference between mitral and pulmonary venous flow duration at atrial contraction are independent determinants of left ventricular filling pressures in patients with coronary artery disease. The additive value of left atrial size and Doppler variables in estimating filling pressures and the possibility that left atrial size may be less age dependent than other mitral and pulmonary venous flow velocity variables merit further investigation.
本研究旨在确定冠心病患者的左心房大小和射血分数是否与左心室充盈压相关。
在冠心病患者中，可通过使用多普勒二尖瓣和肺静脉血流速度变量来估计左心室充盈压。然而，由于这些血流速度与年龄相关，因此需要额外的变量来指示左心室充盈压升高，以提高诊断准确性。
对70例接受心导管检查的患者进行超声心动图测量左心房大小、多普勒二尖瓣和肺静脉血流速度变量，并与左心室充盈压进行相关性分析。
左心室充盈压升高的患者，其左心房大小和容积更大，左心房射血分数更低。平均肺毛细血管楔压与二尖瓣E/A波速度比值（r = 0.72）、左心房最小容积（r = 0.70）、左心房射血分数（r = -0.66）和心房充盈分数（r = -0.66）相关。左心室舒张末期和A波压力与肺静脉和二尖瓣A波持续时间的差值相关（两者r = 0.77）。通过逐步多元线性回归分析，二尖瓣E/A波速度比值是肺毛细血管楔压（r = 0.63）和左心室A波前压力（r = 0.75）的最重要决定因素，而肺静脉和二尖瓣A波持续时间的差值是左心室A波压力（r = 0.75）和左心室舒张末期压力（r = 0.80）的最重要变量。左心房最小容积> 40 cm³用于识别平均肺毛细血管楔压> 12 mmHg的敏感性为82%，特异性为98%。
左心房大小、左心房射血分数以及心房收缩时二尖瓣和肺静脉血流持续时间的差值是冠心病患者左心室充盈压的独立决定因素。左心房大小和多普勒变量在估计充盈压方面的附加价值，以及左心房大小可能比其他二尖瓣和肺静脉血流速度变量受年龄影响更小的可能性，值得进一步研究。
