THE RELATIONSHIP BETWEEN SYSTOLIC ANTERIOR MOTION OF THE MITRAL-VALVE AND THE LEFT-VENTRICULAR OUTFLOW TRACT DOPPLER IN HYPERTROPHIC CARDIOMYOPATHY

被引:10
作者
LIN, CS [1 ]
CHEN, KS [1 ]
LIN, MC [1 ]
FU, MC [1 ]
TANG, SM [1 ]
机构
[1] CHUNG SHAN MED & DENT COLL HOSP,DEPT INTERNAL MED,TAICHUNG,TAIWAN
关键词
D O I
10.1016/0002-8703(91)90286-Q
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
In an attempt to investigate the role of left ventricular blood outflow in the generation of systolic anterior motion (SAM) of the mitral valve in patients with hypertrophic cardiomyopathy, we precisely analyzed the temporal relation of SAM and the left ventricular outflow tract (LVOT) systolic Doppler events obtained at the maximal mitral-septal apposition or equivalent area in eight patients with severe SAM, in five patients with mild/moderate SAM, and in seven patients with no SAM, using M-mode and pulsed Doppler echocardiography; the results were compared with those in 10 normal subjects. In all 13 patients with SAM, the timing of SAM generation corresponded to the LVOT Doppler events either between the onset of SAM and the onset of Doppler (r = 0.834, p < 0.0001) or between the peak of SAM and the peak of Doppler (r = 0.836, p < 0.0001). The excursion rate of the development of SAM showed a correlation with the LVOT blood outflow acceleration (r = 0.828, p < 0.0001). The timing of SAM resolution also correlated with the Doppler events, either between the offset of SAM and the offset of Doppler (r = 0.795, p < 0.001) or the end of SAM and the end of Doppler (r = 0.859, p < 0.0001). The LVOT blood outflow deceleration showed a correlation with the regression rate of SAM (r = 0.668, p < 0.013). The LVOT blood outflow acceleration was significantly higher in patients with severe SAM than in patients with mild/moderate SAM or no SAM. This study suggests that the high LVOT blood outflow acceleration in early systole possibly plays an important part in the generation of the Bernoulli pressure drop and results in anterior motion of the mitral valve. At mid-systole, a drag force and/or suction effect of pressure drop produced by continuous outflow blood may sustain the anterior motion of the mitral valve. At late systole, as the blood flow decelerates, the regression of SAM then occurs.
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页码:1671 / 1682
页数:12
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