Boudoulas H, Boudoulas D, Sparks E A, Pearson A C, Nagaraja H N, Wooley C F
Ohio State University Medical Center, Division of Cardiology, Columbus 43210, USA.
J Heart Valve Dis. 1995 Oct;4 Suppl 2:S242-7; discussion S248.
Multidimensional left atrial (LA) performance indices have not been extensively studied in chronic mitral valve disease. LA maximal volume, stroke volume (LA volume at atrial systole minus LA minimal volume), LA ejection fraction (stroke volume/volume at atrial systole) and A-wave velocity, were measured in 14 patients with mitral stenosis (mean mitral valve area 1.5 cm2); 14 patients with chronic mitral regurgitation all in sinus rhythm; and were compared to 20 age and sex matched normal control subjects using biplane transthoracic echo and pulsed Doppler. Although LA volumes--maximal and at onset of atrial systole--were greater in mitral regurgitation and mitral stenosis (p < 0.01) compared to normal subjects, LA ejection fraction was not statistically different among the three groups. LA stroke volume was greater in mitral regurgitation and mitral stenosis compared to normal subjects, p < 0.01. LA kinetic energy (LAKE) = 1/2 mv2 (m = LA stroke volume x 1.06, blood's specific gravity, v = A wave velocity) was increased in mitral stenosis and mitral regurgitation compared to normal subjects (p < 0.001). An inverse correlation (r = 0.66, p < 0.01) was present between LAKE and mitral valve area in mitral stenosis. It is concluded that LA function, a complex interplay of multiple factors, requires multidimensional methods of analysis beyond standard measurements of size and volume, which provide additional insight into normal LA function, and better definition of LA function changes involved in the natural history of chronic mitral valve disease.
在慢性二尖瓣疾病中，尚未对多维左心房（LA）功能指标进行广泛研究。对14例二尖瓣狭窄患者（平均二尖瓣面积1.5 cm²）、14例均为窦性心律的慢性二尖瓣反流患者，使用双平面经胸超声心动图和脉冲多普勒测量其左心房最大容积、每搏量（心房收缩期左心房容积减去左心房最小容积）、左心房射血分数（每搏量/心房收缩期容积）和A波速度，并与20名年龄和性别匹配的正常对照者进行比较。虽然与正常受试者相比，二尖瓣反流和二尖瓣狭窄患者的左心房容积（最大容积和心房收缩期开始时的容积）更大（p < 0.01），但三组之间的左心房射血分数无统计学差异。与正常受试者相比，二尖瓣反流和二尖瓣狭窄患者的左心房每搏量更大，p < 0.01。与正常受试者相比，二尖瓣狭窄和二尖瓣反流患者的左心房动能（LAKE）= 1/2 mv²（m =左心房每搏量×1.06，血液比重，v = A波速度）增加（p < 0.001）。二尖瓣狭窄患者中，左心房动能与二尖瓣面积呈负相关（r = 0.66，p < 0.01）。结论是，左心房功能是多种因素的复杂相互作用，需要超越大小和容积标准测量的多维分析方法，这有助于进一步了解正常左心房功能，并更好地定义慢性二尖瓣疾病自然病程中涉及的左心房功能变化。
