Fischl S J, Gorlin R, Herman M V
Am J Cardiol. 1977 Feb;39(2):170-6. doi: 10.1016/s0002-9149(77)80187-2.
Left ventricular shape and function were studied in 12 normal subjects, 18 patients with pressure overloading secondary to isolated aortic stenosis and 20 patients with volume overloading due to aortic regurgitation. End-diastolic volumes were mildly increased in aortic stenosis but greatly increased in aortic regurgitation. Average ejection fractions were normal in aortic stenosis but depressed in aortic regurgitation. Ventricular shape (eccentricity), normal (elongated) in nearly all patients with aortic stenosis, showed in diastole various degrees of abnormal roundness in patients with aortic regurgitation. As ventricular function declined in aortic regurgitation, the ventricles also became more round in systole. After valve surgery, clinical results were generally better in patients with aortic stenosis than in patients with aortic regurgitation. Among the latter, changes in eccentricity and ejection fraction were the best predictors of surgical outcome. It is postulated that chronic volume loading, as exemplified by aortic regurgitation, may induce basic alterations in architecture and fiber alignment of the left ventricular wall. Such changes may exert significant influence on the clinical course of these patients.
对12名正常受试者、18名继发于单纯主动脉瓣狭窄的压力负荷过重患者以及20名因主动脉瓣反流导致容量负荷过重的患者的左心室形态和功能进行了研究。主动脉瓣狭窄患者的舒张末期容积轻度增加，而主动脉瓣反流患者的舒张末期容积大幅增加。主动脉瓣狭窄患者的平均射血分数正常，但主动脉瓣反流患者的平均射血分数降低。几乎所有主动脉瓣狭窄患者的心室形态（离心率）正常（呈椭圆形），而主动脉瓣反流患者在舒张期表现出不同程度的异常圆形。随着主动脉瓣反流患者心室功能下降，心室在收缩期也变得更圆。瓣膜手术后，主动脉瓣狭窄患者的临床结果总体上比主动脉瓣反流患者更好。在后者中，离心率和射血分数的变化是手术结果的最佳预测指标。据推测，以主动脉瓣反流为例的慢性容量负荷可能会引起左心室壁结构和纤维排列的基本改变。这些变化可能会对这些患者的临床病程产生重大影响。
