AN APPROACH TO THE ACCELERATIVE PHENOMENA OF LEFT VENTRICULAR PRESSURE GENERATION DURING PRE-EJECTION PHASE : A concept of "dominance index (t(dP/dt)/P)"

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概要

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• A relation ship between the upstroke pattern of LV dP/dt and LV myocardial function was investigated in 37 patients with various cardiovascular diseases. A Millar's catheter-tip micromanometer was used to attain high fidelity of LV pressure pulse. The parameter t[(dP/dt)+(dP/dt)_0]/P was measured at each 5 mmHg increments of LV developed pressure (total pressure minus LV end-diastolic pressure). Where the (dP/dt)_0 is a value of dP/dt at the corresponding point to LVEDP and is usually zero. The values of t[(dP/dt)+(dP/dt)_0]/P varied with time during the pre-ejection phase, having the tendency to increase to a miximum and then to decrease. D(t_<50>), which is the value of t[(dP/dt)+(dP/dt)_0]/P calculated at the LV developed pressure of 50 mmHg, correlated well with SV/mass (r=-0.70) and SW/mass (r=0.69). There was no significant relationship between D(t_<50>) between the normal and the abnormal LV function groups (2.20±0.21, and 1.78±0.10, respectively: p<0.001), and also between the normal and cardiomyopathy (CM) groups (1.76±0.11: p<0.001). Two patients with CM whose LV biopsy findings showed severe myocardial fibrosis had low D(t_<50>) values of 1.58 and 1.66, respectively, while a patient diagnosed as having post-myocarditis had a significantly higher value of D(t_<50>), 2.25. He was shown to have a minimal myocardial damage on LV biopsy, and his clinical course was excellent. D(t_<50>) in a patient who had myocardial infarction was also significantly low. The theoretical base of t[(dP/dt)+(dP/dt)_0]/P was also discussed. From these, it is suggested that t[(dP/dt)+(dP/dt)_0]/P, termed as a "dominance index", which indicates the degree of dominance of the upward or downward convexes of the dP/dt curve, assesses the myocardial function and reflects the myocardial property. Hence, the importance of the accelerative phenomena of the LV pressure during the pre-ejection phase was stressed.

• 社団法人日本循環器学会の論文
• 1978-01-20

著者

• Kumada Toshiaki

  The 3rd Div., Dept, of Intern. Med., Fuculty of Med., Kyoto Univ.

• Kumada Toshiaki

  The 3rd Division Department Of Lnternal Medicine Faculty Of Medicine Kyoto University

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• AN APPROACH TO THE ACCELERATIVE PHENOMENA OF LEFT VENTRICULAR PRESSURE GENERATION DURING PRE-EJECTION PHASE : A concept of "dominance index (t(dP/dt)/P)"

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