Spooner P H, Perry M P, Brandenburg R O, Pennock G D
Department of Medicine, Tucson Veterans Affairs Medical Center and University of Arizona 85723, USA.
J Am Coll Cardiol. 1998 Nov 15;32(6):1589-95. doi: 10.1016/s0735-1097(98)00438-0.
The purpose of this study was to determine the frequency, clinical features and echocardiographic characteristics of increased intraventricular velocities (IIVs) in patients referred to the echocardiography laboratory for systolic murmur.
A subset of patients referred to the echocardiography laboratory for evaluation of a systolic murmur have IIVs in the absence of other recognized causes of systolic murmur.
We prospectively studied echocardiograms from 108 consecutive patients referred for evaluation of a systolic murmur. Clinical data were obtained from patient examinations and medical records.
The sole explanation for systolic murmur was IIVs in 16.7% of referred patients. Compared with those without IIVs, patients with IIVs had a higher ejection fraction (EF) (58.7+/-7.8% vs. 51.1+/-12.5%, p < 0.001), percent fractional shortening (42.3+/-9.7% vs. 31.0+/-11.4%, p < 0.0001), left ventricular (LV) mass index (181+/-70 vs. 152+/-48 g/m2, p=0.046) and prevalence of hypertension (73.3% vs. 51.7%, p=0.043) and a lower prevalence of segmental wall motion abnormalities (2.2% vs. 39.3%, p < 0.001).
Increased intraventricular velocities are a common cause of systolic murmur in this group of patients and should be included in the differential diagnosis of systolic murmurs in adults. The association of IIVs with LV hypertrophy should be a clinical consideration when these murmurs are identified.
本研究旨在确定因收缩期杂音而转诊至超声心动图实验室的患者中，心室内速度增加（IIVs）的频率、临床特征及超声心动图特点。
在因收缩期杂音而转诊至超声心动图实验室进行评估的患者中，有一部分患者存在心室内速度增加，但无其他已确认的收缩期杂音病因。
我们前瞻性地研究了连续108例因收缩期杂音而转诊进行评估的患者的超声心动图。临床资料来自患者检查及病历。
在转诊患者中，16.7%的患者收缩期杂音的唯一原因是心室内速度增加。与无心室内速度增加的患者相比，有心室内速度增加的患者射血分数（EF）更高（58.7±7.8% 对 51.1±12.5%，p<0.001）、缩短分数百分比更高（42.3±9.7% 对 31.0±11.4%，p<0.0001）、左心室（LV）质量指数更高（181±70 对 152±48 g/m²，p=0.046）、高血压患病率更高（73.3% 对 51.7%，p=0.043），节段性室壁运动异常的患病率更低（2.2% 对 39.3%，p<0.001）。
心室内速度增加是该组患者收缩期杂音的常见原因，应纳入成人收缩期杂音的鉴别诊断。当识别出这些杂音时，心室内速度增加与左心室肥厚的关联应作为临床考虑因素。
