Abdalla I, Murray R D, Lee J C, Stewart W J, Tajik A J, Klein A L
Department of Cardiology, The Cleveland Clinic Foundation, OH 44195, USA.
J Am Soc Echocardiogr. 1998 Dec;11(12):1125-33. doi: 10.1016/s0894-7317(98)80007-2.
Transmitral Doppler flow patterns of patients with cardiac amyloidosis evolve from an early impaired relaxation to an advanced restrictive pattern. This reflects increasing severity of diastolic dysfunction and hence left ventricular filling pressures. The duration of the pulmonary venous atrial reversal flow was recently shown to exceed that of the mitral inflow A wave in patients with left ventricular end-diastolic pressure greater than 15 mm Hg. The objective of this study was to assess the utility of this index as a measure of the severity of cardiac amyloidosis. Comprehensive transthoracic 2-dimensional and pulsed-wave Doppler echocardiograms of the pulmonary venous and transmitral flows were made of 23 patients (10 women) with biopsy-proven diagnosis of primary systemic amyloidosis and of 49 subjects as age-matched normal controls. The amyloidosis group was divided into non-restrictive and restrictive subgroups on the basis of the patients' transmitral inflow deceleration time (>150 and < or =150 ms, respectively). The durations of the pulmonary venous atrial reversal and mitral inflow A wave were measured, and the differences between the flow durations were compared with the control and published data in the nonrestrictive and restrictive groups. The mean duration of the pulmonary venous atrial reversal was significantly longer in the amyloid than the control group (P < .01). The mean duration of the mitral inflow A wave was significantly shorter in the restrictive group than both the nonrestrictive and the control groups (P < .05). The duration of the pulmonary venous atrial reversal exceeded that of the mitral inflow A wave in all patients with cardiac amyloidosis. The difference in duration between pulmonary venous atrial reversal and mitral inflow A wave was significantly greater in the amyloidosis group compared with the normal group, and this index varied significantly within the amyloid group between the abnormal relaxation and the restrictive groups. The difference in the duration between the pulmonary venous atrial reversal and the mitral inflow A wave is a reliable index of diastolic function and can be used to assess the severity of cardiac amyloidosis.
心脏淀粉样变性患者的经二尖瓣多普勒血流模式从早期舒张功能受损发展为晚期限制性模式。这反映了舒张功能障碍的严重程度增加，进而反映了左心室充盈压升高。最近研究表明，左心室舒张末压大于15 mmHg的患者，肺静脉心房逆向血流持续时间超过二尖瓣流入A波持续时间。本研究的目的是评估该指标作为心脏淀粉样变性严重程度衡量指标的实用性。对23例经活检证实为原发性系统性淀粉样变性的患者（10例女性）和49例年龄匹配的正常对照者进行了全面的经胸二维和脉冲波多普勒超声心动图检查，观察肺静脉和经二尖瓣血流情况。根据患者二尖瓣流入减速时间（分别>150和≤150 ms），将淀粉样变性组分为非限制性和限制性亚组。测量肺静脉心房逆向血流和二尖瓣流入A波的持续时间，并将血流持续时间的差异与对照组以及非限制性和限制性组已发表的数据进行比较。淀粉样变性组肺静脉心房逆向血流的平均持续时间显著长于对照组（P <.01）。限制性组二尖瓣流入A波的平均持续时间显著短于非限制性组和对照组（P <.05）。所有心脏淀粉样变性患者的肺静脉心房逆向血流持续时间均超过二尖瓣流入A波持续时间。与正常组相比，淀粉样变性组肺静脉心房逆向血流与二尖瓣流入A波持续时间的差异显著更大，且该指标在淀粉样变性组内异常舒张组和限制性组之间差异显著。肺静脉心房逆向血流与二尖瓣流入A波持续时间的差异是舒张功能的可靠指标，可用于评估心脏淀粉样变性的严重程度。
