影治 好美, 大木 崇, 井内 新, 田畑 智継, 福田 信夫

Yoshimi KAGEJI, Takashi OKI, Arata IUCHI, Tomotsugu TABATA, Nobuo FUKUDA

徳島大学第2内科

Second Department of Internal Medicine, School of Medicine, Tokushima University

キーワード : Pulmonary venous flow, Left ventricular inflow, Pulmonary capillary wedge pressure, Left atrial performance, Atrial contraction

To determine whether left ventricular inflow (LVIF) and pulmonary venous flow (PVF) velocity patterns can be used to evaluate the left atrial and ventricular relationship during atrial contraction, we performed transesophageal pulsed Doppler echocardiography (TEE) and right-side heart catheterization on 56 patients [10 with hypertrophic cardiomyopathy (HCM), 10 with dilated cardiomyopathy (DCM), 26 with myocardial infarction (MI), 10 with severe mitral regurgitation (MR)], and 10 normal (N) subjects. Pulsed Doppler variables from the PVF and LVIF during atrial contraction were compared with the mean pulmonary capillary wedge pressure (mean PCWP), the pressure rise in PCWP tracing (PCWP-A), and the volume change in the left atrium (ΔLAV) calculated on the basis of the left atrial dimension by M-mode echocardiography during atrial contraction.
The results were as follows: 1) Mean PCWP correlated closely to the peak velocities of the atrial contraction waves of the LVIF (LVIF-A: r=-0.42, p The above results suggest that PVA reflected pressure changes well, and the amount of the LVIF-A and PVA (TAI) time-velocity integrals reflected volume changes in the left atrium during atrial contraction well. Therefore, a less invasire analysis of LVIF and PVF by TEE can be a good indicator to evaluate the left atrial and ventricular relationship during atrial contraction in patients with various myocardial diseases.