Pinamonti B, Di Lenarda A, Sinagra G, Camerini F
Department of Cardiology, Ospedale Maggiore, Trieste, Italy.
J Am Coll Cardiol. 1993 Sep;22(3):808-15. doi: 10.1016/0735-1097(93)90195-7.
This study was undertaken to evaluate the frequency of restrictive left ventricular filling pattern in dilated cardiomyopathy, as well as its clinical and hemodynamic correlations and prognostic implications.
In dilated cardiomyopathy, as in other heart diseases, different left ventricular filling patterns were observed on Doppler echocardiography. Some patients showed a "restrictive filling pattern," similar to that associated with restrictive cardiomyopathy, characterized by predominant E waves and a shortened E deceleration time.
Pulsed Doppler transmitral curves were analyzed in 79 consecutive patients with dilated cardiomyopathy assigned to two study groups according to E deceleration time: group 1 (n = 36) had a restrictive left ventricular filling pattern (E deceleration time < 115 ms); group 2 (n = 43) had an E deceleration time > or = 115 ms.
Patients in group 1 were significantly younger, in a higher New York Heart Association functional class, more frequently had a third heart sound and had a higher left ventricular filling pressure at catheterization. In addition, they showed more severe left and right ventricular dysfunction and dilation, a larger left atrium and more severe mitral regurgitation. A restrictive filling pattern was associated at Doppler study with a higher E wave velocity, lower A wave velocity and higher E/A ratio. During a follow-up interval of 22 +/- 14 months, all 14 patients who subsequently died or required heart transplantation showed a restrictive left ventricular filling pattern. At multivariate analysis, E deceleration time was the most powerful independent prognostic indicator of poor outcome or transplantation.
Restrictive left ventricular filling pattern is frequent in dilated cardiomyopathy, is associated with more severe disease and is a powerful indicator of increased mortality risk and need for heart transplantation.
本研究旨在评估扩张型心肌病中左心室充盈受限模式的发生率，及其临床、血流动力学相关性和预后意义。
在扩张型心肌病中，如同其他心脏病一样，在多普勒超声心动图上观察到不同的左心室充盈模式。一些患者表现出“限制性充盈模式”，类似于限制性心肌病，其特征为E波占优势且E波减速时间缩短。
对79例连续的扩张型心肌病患者的脉冲多普勒二尖瓣曲线进行分析，根据E波减速时间将其分为两个研究组：第1组（n = 36）有左心室充盈受限模式（E波减速时间<115毫秒）；第2组（n = 43）E波减速时间≥115毫秒。
第1组患者明显更年轻，纽约心脏协会功能分级更高，更频繁出现第三心音，且导管检查时左心室充盈压更高。此外，他们表现出更严重的左、右心室功能障碍和扩张，左心房更大，二尖瓣反流更严重。在多普勒研究中，限制性充盈模式与更高的E波速度、更低的A波速度和更高的E/A比值相关。在22±14个月的随访期间，随后死亡或需要心脏移植的所有14例患者均表现出左心室充盈受限模式。多因素分析显示，E波减速时间是预后不良或需要移植的最有力独立预后指标。
左心室充盈受限模式在扩张型心肌病中很常见，与更严重的疾病相关，是死亡风险增加和需要心脏移植的有力指标。
