Cecconi M, Manfrin M, Zanoli R, Colonna P, Ruga O, Pangrazi A, Soro A
Ospedale Cardiologico G.M. Lancisi, Osimo, Italy.
J Am Soc Echocardiogr. 1996 May-Jun;9(3):241-50. doi: 10.1016/s0894-7317(96)90136-4.
Pulmonary venous flow velocity recordings have been found to be useful in complementing the information obtained from the mitral flow velocity and improving the assessment of left ventricular diastolic pressures. This study was undertaken to evaluate the accuracy of mitral flow and pulmonary venous flow variables, recorded by transthoracic Doppler echocardiography, in estimating left ventricular end-diastolic pressure (LVEDP) in 101 consecutive patients with coronary artery disease undergoing diagnostic left-sided heart catheterization. Patients were assigned to three groups according to the values of LVEDP (group 1, < or = 12 mm Hg; group 2, between 13 and 19 mm Hg; and group 3, > or = 20 mm Hg). LVEDP correlated most strongly with systolic fraction of pulmonary venous flow (r = -0.76), isovolumic relaxation time (r = -0.76), E/A ratio (r = 0.74), deceleration time of early mitral flow (r = -0.74), and mitral A wave duration/pulmonary venous A wave duration (AD/PVAD) ratio (r = -0.70) (p < 0.01 for each correlation). Discriminant analysis demonstrated that deceleration time, AD/PVAD ratio, and isovolumic relaxation time were major determinants of LVEDP, with 87.1% of patients correctly assigned to study groups; 97% of patients of group 1 and 95% of patients of group 3 were identified, whereas the accuracy in identifying the patients of group 2 was lower (41%). Deceleration times of 140 msec or less and AD/PVAD ratios of 0.9 or less were the best cutoff points in predicting an LVEDP of 20 mm Hg or greater. Multiple linear regression analysis demonstrated that the combination of mitral flow and pulmonary venous flow velocity variables provided a better estimation of LVEDP compared with that obtained from mitral flow velocity recordings alone (r = 0.88 versus 0.79; F test, 20.6). We conclude that combined analysis of mitral flow and pulmonary venous flow velocity provides, in patients with coronary artery disease, a noninvasive estimation of LVEDP with an accurate prediction of pressures of 12 mm Hg or less and 20 mm Hg or greater and less accurate prediction of intermediate values.
已发现肺静脉血流速度记录有助于补充从二尖瓣血流速度获得的信息，并改善对左心室舒张压的评估。本研究旨在评估经胸多普勒超声心动图记录的二尖瓣血流和肺静脉血流变量在估计101例连续接受诊断性左侧心导管检查的冠心病患者左心室舒张末期压力（LVEDP）方面的准确性。根据LVEDP值将患者分为三组（第1组，≤12 mmHg；第2组，13至19 mmHg之间；第3组，≥20 mmHg）。LVEDP与肺静脉血流的收缩期分数（r = -0.76）、等容舒张时间（r = -0.76）、E/A比值（r = 0.74）、二尖瓣早期血流减速时间（r = -0.74）以及二尖瓣A波持续时间/肺静脉A波持续时间（AD/PVAD）比值（r = -0.70）相关性最强（各相关性p < 0.01）。判别分析表明，减速时间、AD/PVAD比值和等容舒张时间是LVEDP的主要决定因素，87.1%的患者被正确分配到研究组；第1组97%的患者和第3组95%的患者被识别出来，而识别第2组患者的准确性较低（41%）。140毫秒或更短的减速时间和0.9或更低的AD/PVAD比值是预测LVEDP≥20 mmHg的最佳截断点。多元线性回归分析表明，与仅从二尖瓣血流速度记录获得的结果相比，二尖瓣血流和肺静脉血流速度变量的组合能更好地估计LVEDP（r = 0.88对0.79；F检验，20.6）。我们得出结论，对二尖瓣血流和肺静脉血流速度进行联合分析，在冠心病患者中可对LVEDP进行无创估计，对≤12 mmHg和≥20 mmHg的压力预测准确，对中间值的预测准确性较低。
