Finucci G, Desideri A, Sacerdoti D, Bolognesi M, Merkel C, Angeli P, Gatta A
Dept. of Clinical Medicine, University of Padua, Italy.
Scand J Gastroenterol. 1996 Mar;31(3):279-84. doi: 10.3109/00365529609004879.
Left ventricular systolic abnormalities have been reported in liver cirrhosis (LC). Diastolic function in cirrhotics, on the contrary, does not seem to have been studied so far.
Diastolic function was evaluated in 42 cirrhotic patients and in 16 controls by means of Doppler echocardiography.
Compared with the controls, cirrhotics had increased left ventricular end-diastolic and left atrial volume, stroke volume, late diastolic flow velocity (peak A) (71 + or - 17 cm/sec versus 56 +/- 18; p <0.01), time from onset of mitral inflow to the early peak (time E) (86 + or - 11 msec versus 72 +/- 14; p < 0.003), and deceleration time (DT) (194 +/- 40 msec versus 159 +/- 27; p < 0.001) and decreased ratio of peak E to peak A filling velocities (1.02 +/ - 0.35 versus 1.22 +/- 0.25; p < 0.02). Patients with tense ascites had a higher E/A ratio (p < 0.03) and a shorter DT (p < 0.03) than patients with mild or no ascites.
The impaired left ventricular relaxation in the presence of high stroke volume suggests a myocardial involvement in LC. The pseudo normalization of the E/A ratio and DT in patients with tense ascites could reflect loading conditions masking the relaxation abnormality.
已有报道称肝硬化（LC）患者存在左心室收缩功能异常。相反，目前似乎尚未对肝硬化患者的舒张功能进行研究。
通过多普勒超声心动图对42例肝硬化患者和16例对照者的舒张功能进行评估。
与对照组相比，肝硬化患者的左心室舒张末期容积和左心房容积、每搏输出量、舒张晚期血流速度（A峰）（71±17cm/秒对56±18；p<0.01）、二尖瓣血流起始至E峰的时间（E时间）（86±11毫秒对72±14；p<0.003）以及减速时间（DT）（194±40毫秒对159±27；p<0.001）均增加，而E峰与A峰充盈速度之比降低（1.02±0.35对1.22±0.25；p<0.02）。与轻度腹水或无腹水患者相比，有张力性腹水的患者E/A比值更高（p<0.03），DT更短（p<0.03）。
在每搏输出量较高的情况下左心室舒张功能受损提示肝硬化患者存在心肌受累。有张力性腹水患者E/A比值和DT的假性正常化可能反映了掩盖舒张功能异常的负荷情况。
