Arroja I, Azevedo J, Jacques A, Oliveira A, Amado P, do Valle J C, Marques J C, Araújo V
Laboratório de Ecocardiografia, Hospital Egas Moniz, Lisboa.
Rev Port Cardiol. 1993 Oct;12(10):827-39, 804.
Comparative analysis of left atrial and left ventricle Doppler inflow patterns in patients with essential systemic mild to moderate hypertension and normal global left ventricular systolic function.
A group of out patients with the diagnosis of hypertension referred to the Echocardiographic Laboratory of Egas Moniz Hospital in Lisbon.
Echocardiographic Doppler prospective study.
We studied a group of 50 patients with the diagnosis of mild to moderate arterial hypertension (Group H), which was compared with a population of 50 normal subjects (Group N). In each case we analysed the pulsed Doppler flow of the right upper pulmonary vein and the diastolic inflow of the left ventricular cavity. We calculated the peak velocities and time velocity integrals of the systolic, diastolic and atrial contraction waves of the pulmonary venous flow and also the systo-diastolic velocity and time velocity integral ratios. In the transmitral Doppler flow analysis we evaluated the peak velocities and time velocity integrals of the early (E wave) and late (A wave) waves, and their time velocity and velocity ratio. We assessed also the isovolumic relaxation time and left ventricular mass index.
In groups N and H the peak velocity of the pulmonary venous flow systolic wave was 0.53 +/- 0.15 cm/sec and 0.75 +/- 0.10 cm/sec (p = 0.01), diastolic wave was 0.50 +/- 0.10 cm/sec and 0.41 +/- 0.09 cm/sec (p = 0.03) and atrial contraction wave was 0.18 +/- 0.03 cm/sec and 0.35 +/- 0.08 (p = 0.001), with a systo-diastolic ratio of 1.06 +/- 0.10 and 1.83 +/- 0.10 (p < 0.001), respectively. In these two groups the time velocity integral of the pulmonary venous flow systolic wave was 14.4 +/- 2.6 cm and 17.8 +/- 1.8 cm (p = 0.001), the diastolic wave was 12.5 +/- 3.2 cm and 9.3 +/- 1.3 cm (p = 0.05) and the atrial contraction wave was 4.4 +/- 0.07 cm (p = 0.001), with a systo-diastolic ratio of 1.1 +/- 0.16 and 1.9 +/- 0.12 (p < 0.001), respectively. For the group H and considering the three subgroups, hypertensive patients without anatomical or functional alterations, with isolated diastolic dysfunction and with left ventricular hypertrophy associated to diastolic dysfunction, the velocity systo-diastolic ratio was 1.08 +/- 0.12, 1.57 +/- 0.08 (p < 0.01) and 2.4 +/- 0.08 (p < 0.01) and 2.4 +/- 0.08 (p < 0.001), the systo-diastolic time velocity integral ratio was 1.22 +/- 0.17, 1.72 +/- 0.13 (p < 0.01) and 2.4 +/- 0.15 (p < 0.001), the peak velocity of the atrial contraction wave was 0.28 +/- 0.07, 0.3 +/- 0.08 (p < 0.01) and 0.43 +/- 0.07 (p < 0.001) and its time velocity integral was 4.6 +/- 0.06 cm, 5.6 +/- 0.07 cm (p < 0.01) and 7.0 +/- 0.08 cm (p < 0.001).
Pulsed Doppler study of pulmonary venous flow is significantly abnormal in patients with arterial hypertension. This abnormal pulmonary venous flow pattern has a close relationship with structural and functional alterations of the left ventricle. Combined analysis of the pulsed Doppler inflow at these two cardiac anatomical levels is fundamental to understand the pathophysiology of hypertensive heart disease.
对原发性轻至中度系统性高血压且左心室整体收缩功能正常的患者的左心房和左心室多普勒流入模式进行对比分析。
一组被诊断为高血压的门诊患者，转诊至里斯本埃加斯·莫尼斯医院超声心动图实验室。
超声心动图多普勒前瞻性研究。
我们研究了一组50例被诊断为轻至中度动脉高血压的患者（H组），并与50名正常受试者组成的人群（N组）进行比较。在每种情况下，我们分析右上肺静脉的脉冲多普勒血流以及左心室腔的舒张期血流。我们计算了肺静脉血流收缩期、舒张期和心房收缩期波的峰值速度和时间速度积分，以及收缩期与舒张期速度和时间速度积分比值。在二尖瓣多普勒血流分析中我们评估了早期（E波）和晚期（A波）波的峰值速度和时间速度积分，以及它们的时间速度和速度比值。我们还评估了等容舒张时间和左心室质量指数。
在N组和H组中，肺静脉血流收缩期波的峰值速度分别为0.53±0.15厘米/秒和0.75±0.10厘米/秒（p = 0.01），舒张期波分别为0.50±0.10厘米/秒和0.41±0.09厘米/秒（p = 0.03），心房收缩期波分别为0.18±0.03厘米/秒和0.35±0.08厘米/秒（p = 0.001），收缩期与舒张期比值分别为1.06±0.10和1.83±0.10（p < 0.叭）。在这两组中，肺静脉血流收缩期波的时间速度积分分别为14.4±2.6厘米和17.8±1.8厘米（p = 0.001），舒张期波分别为12.5±3.2厘米和9.3±1.3厘米（p = 0.05），心房收缩期波分别为4.4±0.07厘米（p = 0.001），收缩期与舒张期比值分别为1.1±0.16和1.9±0.12（p < 0.001）。对于H组并考虑三个亚组，即无解剖或功能改变的高血压患者、单纯舒张功能障碍患者以及与舒张功能障碍相关的左心室肥厚患者，收缩期与舒张期速度比值分别为1.08±0.12、1.57±0.08（p < 0.01）和2.4±0.08（p < 0.01）以及2.4±0.08（p < 0.001），收缩期与舒张期时间速度积分比值分别为1.22±0.17、1.7±0.13（p < 0.01）和2.4±0.15（p < 0.001），心房收缩期波的峰值速度分别为0.28±0.07、0.3±0.08（p < O.01）和0.43±0.07（p < 0.001），其时间速度积分分别为4.6±0.06厘米、5.6±0.07厘米（p < 0.01）和7.0±0.08厘米（p < 0.001）。
动脉高血压患者的肺静脉血流脉冲多普勒研究存在显著异常。这种异常的肺静脉血流模式与左心室的结构和功能改变密切相关。对这两个心脏解剖层面的脉冲多普勒流入进行联合分析对于理解高血压性心脏病的病理生理学至关重要。
