Harada K, Suzuki T, Takahashi Y, Ito T, Toyono M, Ishida A, Takada G
Department of Pediatrics, Akita University School of Medicine, Hondo, Japan.
Early Hum Dev. 1998 Jul 10;51(3):197-204. doi: 10.1016/s0378-3782(97)00122-9.
Doppler transmitral flow velocity patterns in assessing left ventricular diastolic function in small-for-gestational-age infants have been poorly understood. The purpose of this study is to examine Doppler filling patterns in small-for-gestational-age infants (n = 13) and to compare them with those in age-matched appropriate-for-gestational-age infants (n = 29). We measured peak flow velocities of early diastole (peak E wave) and atrial contraction (peak A wave), ratio of peak E wave to peak A wave (peak E/A wave), velocity time integrals of E wave (VTIE wave) and A wave (VTIA wave), ratio of VTIE wave to VTIA wave (VTIE/A wave), first third filling fraction, peak filling rate normalized to stroke volume, and deceleration time. Mean gestational age and heart rate did not show a significant difference between the appropriate- and the small-for-gestational-age infants. The mean birth weight in the small-for-gestational-age infants was significantly lower than that in the appropriate-for-gestational-age infants (802+/-220 vs. 1184+/-260 g, P<0.01). In the small-for-gestational-age infants, the peak E wave, peak A wave, peak E/A wave,VTIE wave, first third filling fraction, and peak filling rate normalized to stroke volume were significantly lower than those in the age-matched appropriate-for-gestational-age infants (21.9+/-6.7 vs. 32.2+/-6.9 cm/s, 26.5+/-6.2 vs. 34.5+/-6.2 cm/s, 0.82+/-0.15 vs. 0.93+/-0.14, 1.88+/-0.45 vs. 2.39+/-0.51 cm, 0.36+/-0.04 vs. 0.41+/-0.04, 5.86+/-0.75 vs. 7.11+/-0.63/s, P<0.05, respectively). In the small and appropriate for gestational age infants, peak E wave, VTIE wave, and peak E/A increased significantly with increasing body weight. In the small-for-gestational-age infants, the slopes of regression lines between body weights and peak E wave and VTIE wave were significantly lower than those in the appropriate for gestational age infants, suggesting a significant reduction in E wave even when considering a difference in their body weight. This study suggests that the significant decreases in the early diastolic filling in the small-for-gestational-age infants may be related to the reduced left ventricular diastolic function.
在评估小于胎龄儿左心室舒张功能方面，经二尖瓣血流速度模式一直未被充分理解。本研究的目的是检查小于胎龄儿（n = 13）的多普勒充盈模式，并将其与年龄匹配的适于胎龄儿（n = 29）进行比较。我们测量了舒张早期峰值流速（E峰）和心房收缩峰值流速（A峰）、E峰与A峰的比值（E/A峰）、E波的速度时间积分（VTIE波）和A波的速度时间积分（VTIA波）、VTIE波与VTIA波的比值（VTIE/A波）、前三分之一充盈分数、归一化每搏量的峰值充盈率以及减速时间。适于胎龄儿和小于胎龄儿的平均孕周和心率无显著差异。小于胎龄儿的平均出生体重显著低于适于胎龄儿（802±220 vs. 1184±260 g，P<0.01）。在小于胎龄儿中，E峰、A峰、E/A峰、VTIE波、前三分之一充盈分数以及归一化每搏量的峰值充盈率均显著低于年龄匹配的适于胎龄儿（21.9±6.7 vs. 32.2±6.9 cm/s，26.5±6.2 vs. 34.5±6.2 cm/s，0.82±0.15 vs. 0.93±0.14，1.88±0.45 vs. 2.39±0.51 cm，0.36±0.04 vs. 0.41±0.04，5.86±0.75 vs. 7.11±0.63/s，P均<0.05）。在小于胎龄儿和适于胎龄儿中，E峰、VTIE波和E/A峰均随体重增加而显著增加。在小于胎龄儿中，体重与E峰和VTIE波之间的回归线斜率显著低于适于胎龄儿，这表明即使考虑到体重差异，E波仍显著降低。本研究表明，小于胎龄儿舒张早期充盈的显著降低可能与左心室舒张功能降低有关。
