Davie A P, Francis C M, Caruana L, Sutherland G R, McMurray J J
University of Glasgow, UK.
Eur Heart J. 1997 Jun;18(6):981-4. doi: 10.1093/oxfordjournals.eurheartj.a015387.
It is reported that one third of patients with heart failure have normal left ventricular systolic function, and may or may not have left ventricular diastolic dysfunction. We sought to define the prevalence of left ventricular diastolic filling abnormalities in a large unselected group of patients, unlike the diagnosis by exclusion in the small highly selected groups of patients studied previously.
Patients were referred by general practitioners to an open-access echocardiography service for assessment of possible heart failure. Echocardiography included a Doppler study of transmitral flow at the tips of the mitral leaflets and calculation of an E/A ratio. Of 534 patients referred and assessed, 371 patients had normal systolic function and a measurable E/A ratio. These were compared with age-adjusted reference ranges to give 9 above the reference range and 19 below. This is only 10 more than would be expected if our patients were normal. In the same group of patients we found 96 cases of left ventricular systolic dysfunction, or 52 amongst the 423 with a measurable E/A ratio.
Either left ventricular diastolic filling abnormalities are very much less common than previously supposed or the E/A ratio is almost useless for their detection.
据报道，三分之一的心力衰竭患者左心室收缩功能正常，可能存在或不存在左心室舒张功能障碍。我们试图确定一大组未经选择的患者中左心室舒张期充盈异常的患病率，这与之前研究的一小群经过高度选择的患者通过排除法进行诊断不同。
全科医生将患者转介至开放获取的超声心动图服务部门，以评估可能的心力衰竭。超声心动图包括在二尖瓣叶尖端进行二尖瓣血流的多普勒研究，并计算E/A比值。在534名被转介并接受评估的患者中，371名患者收缩功能正常且E/A比值可测。将这些患者与年龄调整后的参考范围进行比较，结果显示9名患者高于参考范围，19名患者低于参考范围。这仅比我们的患者为正常人群时预期的人数多10人。在同一组患者中，我们发现96例左心室收缩功能障碍，在423例E/A比值可测的患者中有52例。
要么左心室舒张期充盈异常比之前认为的要少见得多，要么E/A比值对其检测几乎毫无用处。
