Briguori C, Betocchi S, Losi M A, Manganelli F, Piscione F, Pace L, Boccalatte M, Gottilla R, Salvatore M, Chiariello M
The Department of Cardiology and Cardiac Surgery, Federico II University School of Medicine, Naples, Italy.
Am J Cardiol. 1998 Jan 15;81(2):180-7. doi: 10.1016/s0002-9149(97)00870-9.
Diastolic dysfunction is common in hypertrophic cardiomyopathy (HC). Previous studies suggest that Doppler transmitral flow velocity profiles, and the left atrial (LA) M-mode echogram can be used noninvasively to evaluate left ventricular (LV) diastolic function. However, this has not been proved in HC. In this study we determined the relation of Doppler transmitral flow velocity profiles and the LA M-mode echograms to invasive indexes of LV diastolic function in patients with HC. We studied 25 patients with HC, while off drugs, and calculated LA global and active fractional shortening and the slope of both early and late displacement of the posterior aortic wall during LA emptying by M-mode echocardiography. We calculated peak velocity of early (E) and atrial (A) filling, E to A ratio, and E-wave deceleration time by pulsed Doppler echocardiography, and simultaneous radionuclide angiography, LV pressures, time constant of isovolumic relaxation tau, and the constant of chamber stiffness k by cardiac catheterization. The time constant of isovolumic relaxation tau correlated with the slope of early posterior aortic wall displacement (r = 0.59; p <0.01). LV end-diastolic pressure correlated with global LA fractional shortening (r = -0.75; p <0.001); the constant of chamber stiffness k correlated with active LA fractional shortening (r = -0.53; p <0.02). In a subset of 13 patients, in whom echocardiography and cardiac catheterization were performed simultaneously, similar results were found. LA M-mode recordings provide a more reliable noninvasive assessment of diastolic function in HC than mitral Doppler indexes.
舒张功能障碍在肥厚型心肌病（HC）中很常见。以往研究表明，多普勒二尖瓣血流速度曲线以及左心房（LA）M型超声心动图可用于无创评估左心室（LV）舒张功能。然而，这在HC中尚未得到证实。在本研究中，我们确定了HC患者的多普勒二尖瓣血流速度曲线和LA M型超声心动图与LV舒张功能有创指标之间的关系。我们研究了25例未服用药物的HC患者，通过M型超声心动图计算LA整体和主动部分缩短率以及LA排空期间主动脉后壁早期和晚期位移的斜率。我们通过脉冲多普勒超声心动图计算早期（E）和心房（A）充盈的峰值速度、E/A比值和E波减速时间，并通过心脏导管检查同时进行放射性核素血管造影、LV压力、等容舒张时间常数τ和腔室僵硬度常数k。等容舒张时间常数τ与主动脉后壁早期位移斜率相关（r = 0.59；p <0.01）。LV舒张末期压力与LA整体部分缩短率相关（r = -0.75；p <0.001）；腔室僵硬度常数k与LA主动部分缩短率相关（r = -0.53；p <0.02）。在13例同时进行超声心动图和心脏导管检查的患者亚组中，发现了类似结果。与二尖瓣多普勒指标相比，LA M型记录为HC舒张功能提供了更可靠的无创评估。
