Yamamoto K, Nishimura R A, Burnett J C, Redfield M M
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA.
J Am Soc Echocardiogr. 1997 Jan-Feb;10(1):52-9. doi: 10.1016/s0894-7317(97)80032-6.
The difference in the durations of flow with atrial contraction (A duration) at the pulmonary veins and mitral valve has been reported to detect the presence of elevated left ventricular end-diastolic pressure. It is postulated that with left ventricular filling during atrial contraction, reduced ventricular compliance results in the transmission of increased pressure into the left atrium, resulting in prolongation of the pulmonary venous flow with atrial contraction. However, the relationship between ventricular compliance during atrial contraction and the pulmonary venous and mitral A durations and their difference have not been carefully examined. We performed recordings of left ventricular pressure and complete Doppler analysis of pulmonary venous and transmitral flow in 87 patients. Operant ventricular compliance at atrial contraction was estimated by measuring the increase in ventricular pressure with atrial contraction (left ventricular a wave) and by using a compliance index, which incorporated an estimate of flow into the ventricle with atrial contraction from the Doppler transmitral a wave. The difference in pulmonary venous and mitral A durations correlated well with left ventricular end-diastolic pressure (r = 0.73, p < 0.01) and the pulmonary venous reversal duration exceeding the duration of the mitral A velocity curve provided high sensitivity (82%) and specificity (92%) for the detection of an end-diastolic pressure of 20 mm Hg or greater. The pulmonary venous A duration increased with a moderate decrease in ventricular compliance but was not increased further in patients with a severe decrease in compliance. In contrast, mitral A duration was not different in patients with moderate reduction in compliance, but was shorter in patients with severe decreases in ventricular compliance. Pulmonary venous and mitral A durations are related to ventricular compliance and they change in an opposite and progressive manner. Their difference is a sensitive method for the detection of the elevated end-diastolic pressure associated with reduction in ventricular compliance.
据报道，肺静脉和二尖瓣处心房收缩期血流持续时间（A波持续时间）的差异可用于检测左心室舒张末期压力升高的情况。据推测，在心房收缩期间左心室充盈时，心室顺应性降低会导致压力升高传递至左心房，从而使肺静脉心房收缩期血流延长。然而，心房收缩期间心室顺应性与肺静脉和二尖瓣A波持续时间及其差异之间的关系尚未得到仔细研究。我们对87例患者进行了左心室压力记录以及肺静脉和二尖瓣血流的完整多普勒分析。通过测量心房收缩时心室压力的升高（左心室a波）并使用一个顺应性指数来估计心房收缩时的心室顺应性，该指数纳入了根据多普勒二尖瓣a波对心房收缩时流入心室的血流的估计。肺静脉和二尖瓣A波持续时间的差异与左心室舒张末期压力密切相关（r = 0.73，p < 0.01），肺静脉血流逆转持续时间超过二尖瓣A波速度曲线的持续时间，对于检测舒张末期压力≥20 mmHg具有较高的敏感性（82%）和特异性（92%）。肺静脉A波持续时间随心室顺应性适度降低而增加，但在顺应性严重降低的患者中并未进一步增加。相比之下，顺应性中度降低的患者二尖瓣A波持续时间无差异，但心室顺应性严重降低的患者二尖瓣A波持续时间较短。肺静脉和二尖瓣A波持续时间与心室顺应性相关，且它们以相反且渐进的方式变化。它们的差异是检测与心室顺应性降低相关的舒张末期压力升高的一种敏感方法。
