Brunner H H, Steiger U, Goebel N H, Krayenbuehl H P
Am Heart J. 1977 Feb;93(2):147-59. doi: 10.1016/s0002-8703(77)80306-2.
This study is to reappraise the usefulness of isovolumic as compared to ejection phase indexes for detecting abnormal left ventricular contractile function patients with a common hemodynamic abnormality, namely, chronic left ventricular pressure overload. In 41 subjects with pure or predominant aortic stenosis left ventricular pressure measurements were performed by micromanometry. Single-plane left ventricular cineangiograms were carried out in the right anterior oblique (RAO) and the A-P position. The isovolumic contractile indexes we used in this study were peak measured velocity of shortening of the contractile elements (Vpm) and Vmax obtained from linear extrapolation of total pressure-velocity curves. The end-diastolic and end-systolic RAO cineventriculograms served for the calculation of the ejection phase parameters mean velocity of circumferential fiber shortening (VCF) and mean normalized systolic ejection rate (MNSER). Of the 41 patients, Vpm was depressed in 16 (39 per cent), Vmax in 17 (42 per cent), VCF in 12 (29 per cent), and MNSER in 14 (34 per cent). When the isovolumic and the ejection phase parameters were combined, 24 patients (59 per cent) were found to have at least one of the four contractile indexes below normal. In 26 of the 41 patients the isovolumic and the ejection phase indexes provided the same conclusions as to normality of left ventricular function. In contrast, 15 patients showed discordant isovolumic and ejection phase indexes. An increased left ventricular end-diastolic pressure was only inconsistently related to an abnormal left ventricular function because in 7 of 28 patients with an end-diastolic pressure above 14 mm. Hg all contractile indexes were normal. Furthermore, a normal end-diastolic pressure was present in three of 24 patients with depressed myocardial function. It is concluded that in chronic left ventricular pressure overload from aortic stenosis neither the isovolumic nor the ejection phase indexes are superior in sensitivity for assessing contractile function. In this clinical setting the combination of both types of indexes appears to be the most reliable way for identifying patients with depressed contractile function of theleft ventricle in the basal state.
本研究旨在重新评估等容收缩期指标与射血期指标在检测伴有常见血流动力学异常（即慢性左心室压力超负荷）的左心室收缩功能异常患者时的有效性。对41例单纯或主要为主动脉瓣狭窄的受试者，采用微测压法进行左心室压力测量。在右前斜位（RAO）和前后位进行单平面左心室 cineangiograms 检查。本研究中使用的等容收缩指标为收缩成分的峰值缩短速度（Vpm）和通过总压力-速度曲线线性外推获得的Vmax。舒张末期和收缩末期的RAO cineventriculograms 用于计算射血期参数圆周纤维缩短平均速度（VCF）和平均标准化收缩射血率（MNSER）。41例患者中，16例（39%）Vpm降低，17例（42%）Vmax降低，12例（29%）VCF降低，14例（34%）MNSER降低。当等容收缩期和射血期参数结合时，发现24例患者（59%）至少有一项收缩指标低于正常。41例患者中有26例的等容收缩期指标和射血期指标对左心室功能正常与否得出相同结论。相反，15例患者的等容收缩期指标和射血期指标不一致。左心室舒张末期压力升高与左心室功能异常的关系并不一致，因为在28例舒张末期压力高于14 mmHg的患者中，有7例所有收缩指标均正常。此外，24例心肌功能降低的患者中有3例舒张末期压力正常。结论是，在主动脉瓣狭窄导致的慢性左心室压力超负荷中，等容收缩期指标和射血期指标在评估收缩功能方面的敏感性均不高。在这种临床情况下，两种指标结合似乎是识别基础状态下左心室收缩功能降低患者的最可靠方法。
