Rakowski H, Appleton C, Chan K L, Dumesnil J G, Honos G, Jue J, Koilpillai C, Lepage S, Martin R P, Mercier L A, O'Kelly B, Prieur T, Sanfilippo A, Sasson Z, Alvarez N, Pruitt R, Thompson C, Tomlinson C
Toronto Hospital, Ontario, Canada.
J Am Soc Echocardiogr. 1996 Sep-Oct;9(5):736-60. doi: 10.1016/s0894-7317(96)90076-0.
Abnormalities of diastolic filling are increasingly recognized as a cause of symptoms and predictors of outcome in patients with most forms of heart disease. Noninvasive assessment of diastolic filling is possible in almost all patients, but accurate evaluation must relate echocardiographic Doppler measurements to the complex physiologic and hemodynamic factors responsible for normal and abnormal filling. This evaluation has been facilitated by recent correlation of Doppler measurement of mitral and pulmonary venous inflow with hemodynamic studies. These studies have confirmed that when a careful, integrated approach is taken, Doppler flow patterns can document a progressive pattern of abnormality in many conditions. Impaired left ventricular (LV) relaxation is seen early and is recognized by a decrease in early transmitral LV filling and an increased proportion of filling during atrial contraction. As abnormalities progress, increasing LV chamber stiffness and elevated left atrial pressure lead to a "pseudonormal" filling pattern that previously has caused considerable confusion. This can be unmasked by careful evaluation of pulmonary venous inflow and the use of the Valsalva maneuver. When marked diastolic abnormalities are present, LV filling has restrictive features characterized by rapid early filling, a very stiff left ventricle with high filling pressures, and a poor prognosis. Routine measurement of indexes of diastolic filling have been hampered by uncertainty as to what should be measured, what techniques should be used, definition of normal values, and a clear method of reporting findings. This report represents the efforts of a Canadian consensus group to define a national standard for the performance and reporting of echocardiographic Doppler studies of diastolic filling.
舒张期充盈异常越来越被认为是大多数形式心脏病患者症状的原因和预后的预测因素。几乎所有患者都可以进行舒张期充盈的无创评估，但准确评估必须将超声心动图多普勒测量结果与负责正常和异常充盈的复杂生理和血流动力学因素联系起来。二尖瓣和肺静脉血流的多普勒测量与血流动力学研究的近期相关性促进了这种评估。这些研究证实，当采用仔细、综合的方法时，多普勒血流模式可以记录许多情况下异常的进展模式。左心室（LV）舒张功能受损在早期可见，表现为左心室舒张期早期经二尖瓣充盈减少和心房收缩期充盈比例增加。随着异常进展，左心室腔僵硬度增加和左心房压力升高导致“假性正常”充盈模式，这以前曾引起相当大的困惑。这可以通过仔细评估肺静脉血流和使用瓦尔萨尔瓦动作来揭示。当存在明显的舒张期异常时，左心室充盈具有限制性特征，表现为早期快速充盈、左心室非常僵硬且充盈压力高以及预后不良。舒张期充盈指标的常规测量因应测量什么、应使用什么技术、正常值的定义以及报告结果的明确方法的不确定性而受到阻碍。本报告代表了一个加拿大共识小组为定义舒张期充盈超声心动图多普勒研究的执行和报告国家标准所做的努力。
