Spinarova L, Toman J, Stejfa M, Soucek M, Richter M, Kara T
1st Department of Internal Medicine, Masaryk University, Brno, Czech Republic.
Int J Cardiol. 1997 May 23;59(3):251-6. doi: 10.1016/s0167-5273(97)02924-0.
In our study we tried to evaluate systolic and diastolic function in patients with chronic heart failure (CHF) by using some echocardiographic parameters and invasively measured pulmonary capillary wedge pressure (PCWP). We studied 19 patients with CHF NYHA II-III at rest, at the end of isometric exercise (handgrip) and during a bicycle stress test. Right heart catheterization and echocardiography were simultaneously performed. We measured exchange of blood gases, end diastolic volume (EDV), end systolic volume (ESV), ejection fraction (EF), peak E velocity, peak A velocity, E/A ratio, deceleration time of E wave (DT), time of mitral regurgitation (MR) and effective filling period of left ventricle (FP). We divided patients according to the median of PCWP at rest into two groups: group A with PCWP< or =11 mmHg (10 pts), group B with PCWP>11 mmHg (9 pts). In group A mean PCWP at rest was 6+/-2 mmHg, during handgrip 12+/-4 mmHg and during bicycle exercise 18+/-6 mmHg. In group B mean values of PCWP were 19+/-6 mmHg, 26+/-11 mmHg and 33+/-5 mmHg, respectively. All values were significantly higher in group B (P<0.01). There was a significant difference in pVO2: in group A 18.8+/-3.5 vs. 14.7+/-3.3 ml/kg per min in group B (P<0.03). No differences between the groups were noticed in EDV, ESV and EF. The E/A ratio in group A was less than 1, in group B greater than 1 with the restrictive pattern. No differences between the groups were observed in MR and FP at rest. During bicycle exercise, MR was significantly longer (284+/-98 vs. 164+/-79 ms; P<0.05) and FP shorter (322+/-99 vs. 421+/-74 ms; P<0.05) in group B than in group A. The functional capacity of patients with CHF is influenced not only by EF and other systolic variables, but also by filling conditions. The duration of effective diastole may be one of the most important of them.
在我们的研究中，我们试图通过使用一些超声心动图参数以及有创测量的肺毛细血管楔压（PCWP）来评估慢性心力衰竭（CHF）患者的收缩和舒张功能。我们研究了19例纽约心脏病协会（NYHA）心功能II - III级的CHF患者，分别在静息状态、等长运动（握力）结束时以及自行车运动负荷试验期间进行观察。同时进行右心导管检查和超声心动图检查。我们测量了血气交换、舒张末期容积（EDV）、收缩末期容积（ESV）、射血分数（EF）、E峰峰值速度、A峰峰值速度、E/A比值、E波减速时间（DT）、二尖瓣反流时间（MR）以及左心室有效充盈期（FP）。我们根据静息时PCWP的中位数将患者分为两组：A组PCWP≤11 mmHg（10例），B组PCWP＞11 mmHg（9例）。A组静息时平均PCWP为6±2 mmHg，握力时为12±4 mmHg，自行车运动时为18±6 mmHg。B组PCWP的平均值分别为19±6 mmHg、26±11 mmHg和33±5 mmHg。B组所有数值均显著更高（P＜0.01）。pVO2存在显著差异：A组为18.8±3.5，B组为14.7±3.3 ml/kg每分钟（P＜0.03）。两组在EDV、ESV和EF方面未观察到差异。A组E/A比值小于1，B组呈限制性模式且大于1。两组在静息时的MR和FP方面未观察到差异。在自行车运动期间，B组的MR显著更长（284±98 vs. 164±79 ms；P＜0.05），而FP更短（322±99 vs. 421±74 ms；P＜0.05）。CHF患者的功能能力不仅受EF和其他收缩变量的影响，还受充盈情况的影响。有效舒张期的时长可能是其中最重要的因素之一。
