Capomolla S, Pozzoli M, Gola A, Maestri R, Sisti M, Cobelli F, Tavazzi L
Divisione di Cardiologia, Centro Medico Montescano Pavia.
G Ital Cardiol. 1996 Oct;26(10):1123-37.
In many cardiac conditions, Doppler of transmitral flow has been showed to be related to left ventricular filling pressure, but several factors may limit its practical value in estimating pulmonary wedge pressure in patients with chronic heart failure. Pulmonary venous velocities directly depend on the oscillations of left atrial pressure. Recent studies suggest that transthoracic Doppler of pulmonary venous flow provides a more accurate estimation of pulmonary wedge pressure. However the relative values of transmitral and pulmonary venous flow for assessing pulmonary wedge pressure in patients with chronic heart failure have not been fully classified until now. Accordingly, we performed this study to assess the feasibility of transthoracic Doppler of pulmonary venous flow in patients with chronic heart failure and to evaluate whether it provides additional information regarding pulmonary wedge pressure when compared with Doppler indices of transmitral flow.
Simultaneous Doppler echocardiographic examinations and right heart catheterizations were performed prospectively in 300 consecutive patients with chronic heart failure due to dilated cardiomyopathy. The correlations of mitral and pulmonary venous flow velocity variables, left atrial volumes, mitral regurgitation jet area and left ventricular ejection fraction with pulmonary artery wedge pressure were evaluated.
A complete recording of transthoracic pulmonary venous flow including all components was obtained in 66% of patients, while only systolic and diastolic forward flow were recorded in 88% of patients. Several indices, derived from pulmonary venous flow, were correlated with pulmonary wedge pressure; the strongest correlation was between systolic fraction of peak velocities and pulmonary wedge pressure (r = -0.76). This value was similar to that obtained between deceleration rate (r = 0.78) and deceleration time (r = -0.67) of transmitral flow and pulmonary wedge pressure. A systolic fraction > 40% showed a greater positive predictive value than restrictive pattern of transmitral flow for identifying patients with pulmonary wedge pressure > 18 mmHg (95% vs 86% p < 0.05). This accuracy is confirmed also in patients who had a single peak of transmitral flow.
Doppler of pulmonary venous flow can be performed in a high percentage of patients with chronic heart failure due to dilated cardiomyopathy. The indices derived from transthoracic pulmonary venous flow are strongly correlated with pulmonary wedge pressure and improve the noninvasive identification of patients with high pulmonary wedge pressure, even when transmitral flow pattern is difficult to be interpreted.
在许多心脏疾病中，经二尖瓣血流多普勒已被证明与左心室充盈压相关，但在慢性心力衰竭患者中，有几个因素可能会限制其在评估肺楔压方面的实际应用价值。肺静脉流速直接取决于左心房压力的波动。最近的研究表明，经胸肺静脉血流多普勒能更准确地评估肺楔压。然而，到目前为止，在慢性心力衰竭患者中，用于评估肺楔压的经二尖瓣和肺静脉血流的相对价值尚未得到充分分类。因此，我们进行了这项研究，以评估经胸肺静脉血流多普勒在慢性心力衰竭患者中的可行性，并评估与经二尖瓣血流多普勒指标相比，它是否能提供有关肺楔压的更多信息。
对300例因扩张型心肌病导致慢性心力衰竭的连续患者进行前瞻性经胸多普勒超声心动图检查和右心导管检查。评估二尖瓣和肺静脉血流速度变量、左心房容积、二尖瓣反流束面积和左心室射血分数与肺动脉楔压的相关性。
66%的患者获得了包括所有成分的完整经胸肺静脉血流记录，而88%的患者仅记录了收缩期和舒张期正向血流。从肺静脉血流得出的几个指标与肺楔压相关；最强的相关性是在峰值速度的收缩期分数与肺楔压之间（r = -0.76）。该值与经二尖瓣血流的减速速率（r = 0.78）和减速时间（r = -0.67）与肺楔压之间获得的值相似。收缩期分数>40%在识别肺楔压>18 mmHg的患者时，比经二尖瓣血流的限制性模式具有更高的阳性预测价值（95%对86%，p<0.05）。在经二尖瓣血流有单个峰值的患者中也证实了这种准确性。
对于因扩张型心肌病导致慢性心力衰竭的患者，较高比例的患者能够进行肺静脉血流多普勒检查。经胸肺静脉血流得出的指标与肺楔压密切相关，即使在经二尖瓣血流模式难以解释时，也能改善对高肺楔压患者的无创识别。
