Schmitz L, Koch H, Bein G, Brockmeier K
Department of Pediatric Cardiology, Virchow-Klinikum, Humboldt-University of Berlin, Children's Hospital, Germany.
J Am Coll Cardiol. 1998 Nov;32(5):1441-8. doi: 10.1016/s0735-1097(98)00379-9.
The aim of this study was to set up reference values for Doppler flow-derived left ventricular filling parameters and to evaluate physiologic determinants of changes in signal expression related to maturation.
In left ventricular diastolic function studies, age-related modulations in signal expression are observed. Assuming degenerative myocardial changes to be absent during childhood and adolescence, the determinants of these modulations must be different from those suspected in adults.
Pulsed wave Doppler signals from the mitral valve tip region were recorded in 329 healthy subjects aged 2 months to 39 years. Multiple linear regression was used to evaluate statistical relations between Doppler flow signals and stroke volume in the mitral valve area.
Increasing early filling time velocity integral throughout maturation caused a decrease in atrial filling fraction from 0.34+/-0.06 to 0.24+/-0.04 (p < 0.005). Peak flow velocities during atrial systole decreased from infancy to adolescence (66+/-15 to 41+/-10 cm/s). Main effects on signal modulation were caused by heart rate, stroke volume and mitral ring area with a linear model fit (R2) of 0.79 for early filling phase (E)-time velocity integral, 0.6 for atrial filling phase peak velocity 0.84 for total E duration and 0.73 for E deceleration time. Atrial filling phase-time velocity integral, albeit significantly dependent on heart rate, was stable throughout growth.
During infancy and childhood, the stroke volume crossing the mitral valve is a main modulator for early filling phase (E)-time velocity integral and diastolic time intervals during early filling, whereas atrial filling phase parameters are mainly dependent on heart rate. This results in a more pronounced atrial filling during infancy and childhood.
本研究旨在建立经多普勒血流得出的左心室充盈参数的参考值，并评估与成熟相关的信号表达变化的生理决定因素。
在左心室舒张功能研究中，观察到信号表达存在与年龄相关的调节。假设在儿童期和青少年期不存在退行性心肌变化，这些调节的决定因素必定与成人中怀疑的因素不同。
记录了329名年龄在2个月至39岁之间的健康受试者二尖瓣尖区的脉冲波多普勒信号。采用多元线性回归评估二尖瓣区多普勒血流信号与每搏量之间的统计关系。
在整个成熟过程中，早期充盈时间速度积分增加，导致心房充盈分数从0.34±0.06降至0.24±0.04（p<0.005）。心房收缩期的峰值流速从婴儿期到青少年期降低（66±15至41±10cm/s）。对信号调节的主要影响由心率、每搏量和二尖瓣环面积引起，早期充盈期（E）时间速度积分的线性模型拟合度（R2）为0.79，心房充盈期峰值速度为0.6，总E持续时间为0.84，E减速时间为0.73。心房充盈期时间速度积分尽管显著依赖于心率，但在整个生长过程中保持稳定。
在婴儿期和儿童期，通过二尖瓣的每搏量是早期充盈期（E）时间速度积分和早期充盈期舒张时间间隔的主要调节因素，而心房充盈期参数主要依赖于心率。这导致婴儿期和儿童期心房充盈更为明显。
