Henein M Y, Xiao H B, Brecker S J, Gibson D G
Cardiac Department, Royal Brompton National Heart and Lung Hospital, London.
Br Heart J. 1993 May;69(5):409-13. doi: 10.1136/hrt.69.5.409.
To study the possible mechanisms underlying the dominant "a" wave in the jugular venous pulse seen in patients with left ventricular hypertrophy (Bernheim "a" wave).
Prospective examination of the left ventricular transverse and longitudinal axes, transmitral and transtricuspid flows, and jugular venous pulse recordings.
Tertiary referral centre for cardiac disease.
23 patients with left ventricular hypertrophy of various aetiologies and a dominant "a" wave in the jugular venous pulse. Controls were 21 normal volunteers.
Early diastolic filling of the right ventricle was normal. During right atrial systole the (mean(SD)) tricuspid ring motion was exaggerated (1.2(0.4) v 0.8(0.2) cm, p < 0.001) and Doppler A wave velocity slightly increased (0.3(0.1) v 0.2(0.08) m/s, p < 0.01), although the E wave remained dominant. By contrast left ventricular isovolumic relaxation time was longer than normal (70(20) v 55(10) ms, p < 0.001) with wall motion incoordinate in the septal long axis, 15%(9.5%) v 6.6%(3%) total excursion occurring before mitral valve opening. During early filling the extent of long axis motion was decreased to 0.6(0.5) cm from 1.1(0.2) cm, (p < 0.001) and 0.5(0.2) cm from 0.9(0.2) cm, (p < 0.0001) at the left and septal sites, and similarly its peak lengthening rate reduced to 5.4(2.5) cm/s from 10(3) cm, (p < 0.001) and 4.3(2.2) cm/s from 8(2) cm, (p < 0.001). The atrial component of long axis lengthening was increased to 43%(18%) from 29%(6%) (p < 0.01) and 55%(15%) from 33%(8%) of the total excursion (p < 0.0001). Left ventricular E/A ratio was less than normal (0.9(0.8) v 1.4(0.4), p < 0.05).
There is no evidence of obstruction or any other disturbance of early diastolic right ventricular inflow in Bernheim's syndrome. It is possible that the haemodynamically appropriate increase in left atrial activity is mirrored on the right side due to shared interatrial myocardial fibres. This could represent a form of atrial interaction.
研究左心室肥厚患者（伯恩海姆“a”波）颈静脉搏动中占主导地位的“a”波潜在的可能机制。
对左心室横轴和纵轴、二尖瓣和三尖瓣血流以及颈静脉搏动记录进行前瞻性检查。
心脏病三级转诊中心。
23例病因各异且颈静脉搏动中有占主导地位“a”波的左心室肥厚患者。对照组为21名正常志愿者。
右心室舒张早期充盈正常。在右心房收缩期时，三尖瓣环运动（均值（标准差））增大（1.2（0.4）厘米对0.8（0.2）厘米，p<0.001），多普勒A波速度略有增加（0.3（0.1）米/秒对0.2（0.08）米/秒），尽管E波仍占主导。相比之下，左心室等容舒张时间长于正常（70（20）毫秒对55（10）毫秒，p<0.001），室间隔长轴壁运动不协调，二尖瓣开放前总偏移的15%（9.5%）对6.6%（3%）。在早期充盈期间，长轴运动范围在左心室部位从1.1（0.2）厘米降至0.6（0.5）厘米（p<0.001），在室间隔部位从0.9（0.2）厘米降至0.5（0.2）厘米（p<0.0001），同样其峰值延长速率从10（3）厘米/秒降至5.4（2.5）厘米/秒（p<0.001），从8（2）厘米/秒降至4.3（2.2）厘米/秒（p<0.001）。长轴延长的心房成分从总偏移的29%（6%）增加至43%（18%）（p<0.01），从33%（8%）增加至55%（15%）（p<0.0001）。左心室E/A比值低于正常（0.9（0.8）对1.4（0.4），p<0.05）。
在伯恩海姆综合征中，没有证据表明存在右心室舒张早期流入道梗阻或任何其他干扰。由于心房肌纤维共享，左心房活动在血流动力学上适当增加可能会反映在右侧。这可能代表一种心房相互作用的形式。
