This study attempted to examine the relation of left ventricular filling patterns to hemodynamic status and left atrial function in dilated cardiomyopathy. Transesophageal echocardiography and cardiac catheterization were performed in 41 patients with dilated cardiomyopathy (six with an ischemic origin). Transmitral, left atrial appendage, and pulmonary venous flow velocities were recorded with the pulsed Doppler method. Left atrial systolic function was assessed by the peak velocity of the left atrial appendage emptying wave and pulmonary venous flow reversal during atrial systole. Patients were classified into three groups according to their left ventricular filling patterns. Group 1 showed an abnormal relaxation pattern (E wave/A wave ratio <1, n = 17), group 2 had a normal or pseudonormal pattern (1 < or = E/A < 2, n = 11), and group 3 had a restrictive pattern (E/A > or = 2, n = 13). No differences were found among the groups with regard to age, gender, heart rate, and M-mode echocardiographic indices of left ventricular function. Compared with patients in group 1, those in groups 2 and 3 had more symptoms (New York Heart Association functional class III or IV) and had higher left ventricular filling pressures. The sensitivity of an E/A ratio > or = 1 for predicting a pulmonary capillary wedge pressure > or = 15 mm Hg was 75% and the specificity was 94%. Despite a similar increase of filling pressures, group 3 patients had a lower left atrial appendage emptying velocity, pulmonary venous flow reversal velocity, and mitral A velocity than did group 2 patients. The sensitivity and specificity of an E/A ratio > or = 22 for detecting left atrial dysfunction (left atrial appendage emptying velocity < or = 40 cm/sec) was 85% and 86%, respectively. In conclusion, among patients with dilated cardiomyopathy, those who had a restrictive or pseudonormal filling pattern were in a higher functional class and had higher filling pressures. Further studies are needed to determine the therapeutic and prognostic significance of left atrial dysfunction, which was common in patients with a restrictive pattern.

译文

:这项研究试图检查扩张型心肌病的左心室充盈模式与血流动力学状态和左心房功能的关系。经食道超声心动图和心脏导管检查术治疗了41例扩张型心肌病(其中6例是缺血性)。用脉冲多普勒法记录经颅,左心耳和肺静脉血流速度。通过心房收缩期间左心耳排空波的峰值速度和肺静脉血流逆转来评估左心收缩功能。根据患者的左心室充盈模式将其分为三组。第1组显示异常的放松模式(E波/ A波比<1,n = 17),第2组显示正常或伪正常模式(1 <或= E / A <2,n = 11),第3组显示限制性模式(E / A>或= 2,n = 13)。在年龄,性别,心率和左心室功能的M型超声心动图指数方面,各组之间未发现差异。与第1组的患者相比,第2和3组的患者出现更多症状(纽约心脏协会功能性III或IV级),并且左心室充盈压更高。 E / A比>或= 1对预测肺毛细血管楔压>或= 15 mm Hg的敏感性为75%,特异性为94%。尽管充盈压增加相似,但第3组患者的左心耳排空速度,肺静脉血流逆转速度和二尖瓣A速度均低于第2组患者。 E / A比率>或= 22对检测左心功能不全(左心耳排空速度<或= 40 cm / sec)的敏感性和特异性分别为85%和86%。总之,在扩张型心肌病患者中,充盈受限或假正常的患者功能类别较高,充盈压力较高。需要进一步的研究以确定左心功能不全的治疗和预后意义,这在限制性模式患者中很常见。

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