Völler H, von Ameln H, Spielberg C, Schröder K, Uhrig A, Schröder R
Department of Cardiopulmology, Klinikum Steglitz, University of Berlin, Germany.
J Am Soc Echocardiogr. 1993 May-Jun;6(3 Pt 1):255-64. doi: 10.1016/s0894-7317(14)80061-8.
There is still controversy as to the manner in which Doppler-derived transmitral filling patterns change because of myocardial ischemia. To evaluate the effects of exercise-induced ischemia on Doppler-derived filling patterns, 28 patients were examined at rest and during three stages of supine bicycle exercise (0.5, 1.0, and 1.5 W/kg). The peak early (E) and integrated early (Ei) and peak late (A) and integrated late (Ai) diastolic flow velocities, as well as their ratios (E/A, Ei/Ai), were compared between patients with exercise-induced ischemia but no wall-motion abnormalities at rest (ischemia group, n = 13) and those with akinetic scars from previous infarction but no exercise ischemia (scar group, n = 15). Normal subjects with no evidence of heart disease served as a control group (n = 11). At maximal workload the ischemia group showed a significantly lower peak flow velocity at atrial contraction than the control and scar group (0.74 +/- 0.18 vs 1.08 +/- 0.25 and 0.89 +/- 0.19 m/sec, respectively; p < 0.05) and also a significantly lower flow velocity integral at atrial contraction (8.24 +/- 2.2 vs 12.81 +/- 4.8 and 11.32 +/- 3.6 cm, respectively; p < 0.05). Therefore, the atrial contribution to filling was diminished during ischemia (36.2% +/- 9.2% vs 47.3% +/- 6.4% and 48.4% +/- 13.8%, respectively; p < 0.05). By maintaining the early filling rate during ischemia, the reduced atrial contribution resulted in a significantly higher E/A ratio (1.48 +/- 0.31 vs 1.05 +/- 0.15 and 1.16 +/- 0.44, respectively) and Ei/Ai ratio (2.0 +/- 1.06 vs 1.09 +/- 0.26 and 1.24 +/- 0.79, respectively). The assessment of Doppler-derived transmitral filling during exercise-induced ischemia shows mainly early diastolic filling, which is in contrast to the profile of impaired relaxation usually associated with ischemia. Evidence of exercise-induced ischemia leading to greater increases in left atrial pressure suggests that transmitral filling patterns are more closely related to hemodynamic status than to diastolic function.
关于多普勒得出的经二尖瓣充盈模式因心肌缺血而改变的方式仍存在争议。为了评估运动诱发的缺血对多普勒得出的充盈模式的影响，对28例患者在静息状态以及仰卧位自行车运动的三个阶段（0.5、1.0和1.5W/kg）进行了检查。比较了静息时存在运动诱发的缺血但无室壁运动异常的患者（缺血组，n = 13）与有既往梗死导致的运动不能性瘢痕但无运动诱发缺血的患者（瘢痕组，n = 15）之间的舒张早期峰值（E）、舒张早期积分（Ei）、舒张晚期峰值（A）和舒张晚期积分（Ai）流速，以及它们的比值（E/A、Ei/Ai）。无心脏病证据的正常受试者作为对照组（n = 11）。在最大负荷时，缺血组心房收缩时的峰值流速显著低于对照组和瘢痕组（分别为0.74±0.18 vs 1.08±0.25和0.89±0.19m/秒；p<0.05），心房收缩时的流速积分也显著更低（分别为8.24±2.2 vs 12.81±4.8和11.32±3.6cm；p<0.05）。因此，缺血期间心房对充盈的贡献减少（分别为36.2%±9.2% vs 47.3%±6.4%和48.4%±13.8%；p<0.05）。通过在缺血期间维持早期充盈率，心房贡献的减少导致E/A比值显著更高（分别为1.48±0.31 vs 1.05±0.15和1.16±0.44）以及Ei/Ai比值显著更高（分别为2.0±1.06 vs 1.09±0.26和1.24±0.79）。运动诱发缺血期间经二尖瓣多普勒充盈的评估显示主要为舒张早期充盈，这与通常与缺血相关的舒张功能受损的特征相反。运动诱发缺血导致左心房压力更大升高的证据表明，经二尖瓣充盈模式与血流动力学状态的关系比与舒张功能的关系更密切。
