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英文誌(2004-)

Journal of Medical Ultrasonics

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1989 - Vol.16

Vol.16 No.04

Original Article(原著)

(0333 - 0345)

高度大動脈弁閉鎖不全症における拡張期雑音形態による左室拡張能の評価 -心音図, 心内圧および血流波形の対比検討-

Assessment of Left Ventricular Diastolic Function by the Configuration of Diastolic Murmur in Severe Aortic Regurgitation -Comparative Study of Phonocardiogram, Intracardiac Pressure and Flow Velocity-

鈴木 修

Osamu Suzuki

自治医科大学臨床病理部

Department of Clinical Pathology, Jichi Medical School

キーワード : Aortic regurgitation, Diastolic murmur, Left ventricular diastolic function

We compared the configuration of diastolic regurgitant murmur and the features of Austin Flint murmur with intracardiac pressure and flow velocity pattern in 31 patients with severe isolated aortic regurgitation (AR). The regurgitant murmurs were divided into 4 types on the basis of the mode of attenuation and the presence or absence of presystolic accentuation. Left ventricular end-diastolic pressure (LVEDP), ΔP1 (an increase in LV pressure during the first half of diastole) and ΔP2/SV (an increase of LV pressure during holodiastole/stroke volume) increased in the order of type I (gradual decrease without presystolic accentuation), type II (gradual decrease with presystolic accentuation), type III (rapid decrease lasting to the end of diastole) and type IV (rapid decrease terminating in mid-diastole), indicating the usefulness of this classification of the murmur in evaluating LV diastolic function. The decreasing ratio of diastolic pressure gradient between LV and aorta, one of the determinants of decreasing ratio of murmur's amplitude, was dependent on LV diastolic function. The ratio of peak velocity of transmitral flow during atrial contraction to that during rapid filling phase (A/R) readily derived by Doppler method, showed good correspondence with the configuration of regurgitant murmur and LV pressure curve. Thus, A/R seemed to be a good indicator of LV diastolic function. Austin Flint murmur also appeared to be affected by the LV diastolic function. Our data demonstrated that the configuration of diastolic murmur in severe AR was related to LV diastolic function, and with the additional use of A/R, we could more definitely evaluate LV diastolic function.