Kozan O, Nazli C, Kinay O, Ergene O, Isguzar E, Tamci B, Seyithanoglu B Y, Tekin U, Ergene U, Tastan A, Keskin V
Departments of Cardiology and Emergency Medicine, Dokuz Eylul University Hospital, Inciralti, Izmir, Turkey.
J Am Soc Echocardiogr. 1998 Nov;11(11):1036-43. doi: 10.1016/s0894-7317(98)70154-3.
The aim of this study was to evaluate the use of intraventricular dispersion of the peak diastolic flow velocity as a marker of left ventricular diastolic dysfunction in patients with atrial fibrillation. Regional diastolic flow velocity patterns at 1, 2, and 3 cm away from the mitral tip toward the apex were simultaneously recorded with the mitral flow velocity pattern by using pulsed Doppler echocardiography in 24 patients with atrial fibrillation before electrical or medical cardioversion. Echocardiographic examination was repeated after 10 to 30 days (ie, at the time of recovery of left atrial mechanical functions) after cardioversion of atrial fibrillation in all patients. Thirteen patients were found to have diastolic dysfunction; the remaining 11 patients with a normal E/A ratio constituted the control group. Afterward, the data recorded before the cardioversion were analyzed for each patient. In subjects with normal diastolic function, the peak diastolic flow velocity (PDFV) at the mitral tips also was maintained at the positions 1 to 3 cm away from the tip in the left ventricular cavity (PDFV at the mitral tips: 0.84 m/s, PDFV at 3 cm: 0.85 m/s; P =.34). In contrast, the regional PDFV progressively decreased toward the apex in patients with diastolic dysfunction (PDFV at the mitral tips: 0.82 m/s, PDFV at 3 cm: 0.63 m/s; P =.0004). Only 77% of the initial velocity was maintained at 3 cm away from the mitral tips in patients with diastolic dysfunction, whereas almost 100% of the initial velocity was preserved in patients with normal diastolic function (P <.001). These findings suggest that the assessment of the intraventricular decrease in mitral PDFV may be used as a reliable marker of diastolic dysfunction in patients with atrial fibrillation.
本研究的目的是评估舒张期峰值流速的心室腔内离散度作为心房颤动患者左心室舒张功能障碍标志物的应用。在24例心房颤动患者进行电复律或药物复律前，使用脉冲多普勒超声心动图同时记录二尖瓣瓣尖向心尖方向1、2和3 cm处的局部舒张期流速模式以及二尖瓣流速模式。所有患者在心房颤动复律后10至30天（即左心房机械功能恢复时）重复进行超声心动图检查。发现13例患者存在舒张功能障碍；其余11例E/A比值正常的患者构成对照组。然后，对每位患者复律前记录的数据进行分析。在舒张功能正常的受试者中，二尖瓣瓣尖处的舒张期峰值流速（PDFV）在左心室腔内距瓣尖1至3 cm处也保持稳定（二尖瓣瓣尖处的PDFV：0.84 m/s，3 cm处的PDFV：0.85 m/s；P = 0.34）。相比之下，舒张功能障碍患者的局部PDFV向心尖方向逐渐降低（二尖瓣瓣尖处的PDFV：0.82 m/s，3 cm处的PDFV：0.63 m/s；P = 0.0004）。舒张功能障碍患者在距二尖瓣瓣尖3 cm处仅维持初始流速的77%，而舒张功能正常的患者几乎保留了100%的初始流速（P < 0.001）。这些发现表明，评估二尖瓣PDFV的心室腔内降低情况可作为心房颤动患者舒张功能障碍的可靠标志物。
