Ito T, Suwa M, Hirota Y, Otake Y, Moriguchi A, Kawamura K
Department of Internal Medicine, Osaka Medical College, Japan.
Am Heart J. 1996 Jan;131(1):122-30. doi: 10.1016/s0002-8703(96)90060-5.
Information regarding the relation of left atrial (LA) function to transmitral and pulmonary venous (PV) flow is limited. Using transesophageal echocardiography, we analyzed this relation in 23 patients with dilated cardiomyopathy (DCM) and 25 patients with hypertrophic cardiomyopathy (HCM). Left atrial appendage (LAA) function was assessed as a substitute for overall LA function. Transmitral and PV flow-velocity variables, the LAA emptying flow velocity (LAA-A), and the LAA ejection fraction (LAA-EF) were determined. Each patient group was divided into two subgroups with a normal ( < 15 mm Hg) or elevated ( > or = 15 mm Hg) mean pulmonary wedge pressure (PWP). Transmitral and PV flow patterns as well as LA function were similar in the two subgroups with a normal PWP (11 patients with DCM and 14 patients with HCM). For the subgroups with an elevated PWP, however, the peak velocity ratio of the early filling wave (E) to atrial contraction wave (A) was higher in DCM patients (n = 12) than in HCM patients (n = 11) (2.1 +/- 0.7 vs 1.3 +/- 0.2; p < 0.01). This difference mostly resulted from a lower A velocity in the DCM group than in the HCM group (30 +/- 10 cm/sec vs 43 +/- 7 cm/sec; p < 0.05). In addition, the reverse flow velocity at atrial contraction in the PV was lower in the DCM group than in the HCM group (19 +/- 8 cm/sec vs 37 +/- 8 cm/sec; p < 0.01). These findings were associated with poorer LA systolic function in the DCM group (LAA-A, 35 +/- 13 cm/sec vs 60 +/- 11 cm/sec; LAA-EF, 37% +/- 12% vs 55% +/- 15%, p < 0.05, respectively). Our data suggest that a restrictive transmitral flow pattern develops more easily in DCM than in HCM because LA dysfunction is present in DCM, and that LA contractility plays an important role in determining the atrial contraction wave of transmitral and PV flows with elevated LA pressure.
关于左心房（LA）功能与二尖瓣及肺静脉（PV）血流关系的信息有限。我们采用经食管超声心动图，对23例扩张型心肌病（DCM）患者和25例肥厚型心肌病（HCM）患者的这种关系进行了分析。评估左心耳（LAA）功能以替代整体LA功能。测定二尖瓣和PV血流速度变量、LAA排空血流速度（LAA - A）以及LAA射血分数（LAA - EF）。每个患者组又分为平均肺楔压（PWP）正常（<15 mmHg）或升高（≥15 mmHg）的两个亚组。PWP正常的两个亚组（11例DCM患者和14例HCM患者）的二尖瓣和PV血流模式以及LA功能相似。然而，对于PWP升高的亚组，DCM患者（n = 12）的舒张早期充盈波（E）与心房收缩波（A）的峰值速度比高于HCM患者（n = 11）（2.1±0.7对1.3±0.2；p<0.01）。这种差异主要源于DCM组的A速度低于HCM组（30±10 cm/sec对43±7 cm/sec；p<0.05）。此外，DCM组PV心房收缩期的反向血流速度低于HCM组（19±8 cm/sec对37±8 cm/sec；p<0.01）。这些发现与DCM组较差的LA收缩功能相关（LAA - A，35±13 cm/sec对60±11 cm/sec；LAA - EF，37%±12%对55%±15%，p分别<0.05）。我们的数据表明，由于DCM存在LA功能障碍，DCM比HCM更容易出现限制性二尖瓣血流模式，并且LA收缩性在LA压力升高时决定二尖瓣和PV血流的心房收缩波中起重要作用。
