Takatsuji H, Mikami T, Urasawa K, Teranishi J, Onozuka H, Takagi C, Makita Y, Matsuo H, Kusuoka H, Kitabatake A
Department of Cardiovascular Medicine, Hokkaido University School of Medicine, Sapporo, Japan.
J Am Coll Cardiol. 1996 Feb;27(2):365-71. doi: 10.1016/0735-1097(96)81240-x.
To evaluate left ventricular diastolic function and differentiate the pseudonormalized transmitral flow pattern from the normal pattern, the propagation of left ventricular early filling flow was assessed quantitatively using color M-mode Doppler echocardiography.
Because the propagation of left ventricular early filling flow is disturbed in the left ventricle with impaired relaxation, quantification of such alterations should provide useful indexes for the evaluation of left ventricular diastolic function.
Study subjects were classified into three groups according to the ratio of early to late transmitral flow velocity (E/A ratio) and left ventricular ejection fraction: 29 subjects with an ejection fraction > or = 60% (control group); 34 with an ejection fraction < 60% and E/A ratio < 1 (group I); and 25 with ejection fraction < 60% and E/A ratio > or = 1 (group II). The propagation of peak early filling flow was visualized by changing the first aliasing limit of the color Doppler signals. The rate of propagation of peak early filling flow velocity was defined as the distance/time ratio between two sampling points: the point of the maximal velocity around the mitral orifice and the point in the mid-left ventricle at which the velocity decreased to 70% of its initial value. High fidelity manometer-tipped measurement was performed in 40 randomly selected subjects.
The rate of propagation decreased in groups I and II compared with that in the control group (33.8 +/- 13.8 [mean +/- SD] and 30.0 +/- 8.6 vs. 74.3 +/- 17.4 cm/s, p < 0.001, respectively) and correlated inversely with the time constant of left ventricular isovolumetric relaxation and the minimal first derivative of left ventricular pressure (peak negative dP/dt) (r = 0.82 and r = 0.72, respectively).
Spatial and temporal analysis of filling flow propagation by color M-mode Doppler echocardiography was free of pseudonormalization and correlated well with the invasive variables of left ventricular relaxation.
为评估左心室舒张功能并区分伪正常化二尖瓣血流模式与正常模式，采用彩色M型多普勒超声心动图对左心室早期充盈血流的传播进行定量评估。
由于左心室舒张功能受损时左心室早期充盈血流的传播会受到干扰，对这种改变进行量化可为评估左心室舒张功能提供有用指标。
根据二尖瓣血流速度早期与晚期比值（E/A比值）及左心室射血分数，将研究对象分为三组：29名射血分数≥60%的受试者（对照组）；34名射血分数<60%且E/A比值<1的受试者（I组）；以及25名射血分数<60%且E/A比值≥1的受试者（II组）。通过改变彩色多普勒信号的第一混叠极限来观察早期充盈血流峰值的传播。早期充盈血流峰值速度的传播速率定义为两个采样点之间的距离/时间比：二尖瓣口周围最大速度点和左心室中部速度降至初始值70%的点。对40名随机选择的受试者进行了高保真压力传感器尖端测量。
与对照组相比，I组和II组的传播速率降低（分别为33.8±13.8[均值±标准差]和30.0±8.6，而对照组为74.3±17.4 cm/s，p<0.001），且与左心室等容舒张时间常数和左心室压力的最小一阶导数（峰值负dP/dt）呈负相关（分别为r = 0.82和r = 0.72）。
彩色M型多普勒超声心动图对充盈血流传播进行的空间和时间分析无伪正常化现象，且与左心室舒张的有创变量相关性良好。
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