Valsalva动作在非肥厚型心肌病患者隐匿性左心室流出道梗阻诊断中的应用  

Application of Valsalva maneuver in detection of occult left ventricular outflow tract obstruction in patients without hypertrophic cardiomyopathy

作　　者：艾慧俊[1] 施振华[2] 陈君美 戴丽雅 周宁[1] 陈方红[1] AI Huijun;SHI Zhenhua;CHEN Junmei;DAI Liya;ZHOU Ning;CHEN Fanghong(Department of Ultrasonography,Lishui Municipal Central Hospital,Lishui 323000,China;不详)

机构地区：[1]丽水市中心医院超声科,323000 [2]丽水市中心医院心内科,323000

出　　处：《心电与循环》2022年第3期250-253,257,共5页Journal of Electrocardiology and Circulation

摘　　要：目的探讨Valsalva动作在非肥厚型心肌病患者隐匿性左心室流出道梗阻诊断中的应用。方法选择2019年5月至2021年12月丽水市中心医院不典型胸痛患者800例,行常规超声心动图联合Valsalva动作检查。测量静息期及Valsalva动作后二尖瓣口舒张早期峰值流速(E)、舒张晚期峰值流速(A)、比值(E/A)、左心室舒张末期容积(LVEDV)、左心室流出道流速及压差的水平变化。结果发现隐匿性左心室流出道梗阻57例(7.13%),其中二尖瓣前叶冗长5例(8.77%),左心室假腱索3例(5.26%),乳头肌肥大3例(5.26%),室间隔增厚28例(49.12%),室间隔成角7例(12.28%),混合型(两种及以上)11例(19.30%)。隐匿性左心室流出道梗阻患者Valsalva动作后的E、A、E/A,LVEDV均低于静息状态水平,左心室流出道流速、压差均高于静息状态水平,差异均有统计学意义(均P<0.05)。结论Valsalva动作可用于不典型胸痛患者隐匿性左心室流出道梗阻的检测。Objective To investigate the application of Valsalva maneuver in detection of occult left ventricular outflow tract obstruction(LVOTO)in patients without hypertrophic cardiomyopathy.Methods A total of 800 patients underwent routine echocardiography combined with Valsalva maneuver for atypical chest pain in Lishui Central Hospital from May2019 to December 2021.Peak early diastolic transmitral flow velocity(E)and peak late diastolic transmitral flow velocity(A),E/A ratio,left ventricular end diastolic volume(LVEDV),left ventricular outflow tract velocity and pressure gradient were measured at rest and with Valsalva maneuver.Results Occult LVOTO was detected in 57 cases(7.13%),including 5 cases(8.77%)with longer anterior mitral leaflet,3 cases(5.26%)with left ventricular false tendon,3 cases(5.26%)with hypertrophic papillary muscle,28 cases(49.12%)with basal septal hypertrophy,7 cases(12.28%)with septal angulation and 11cases(19.30%)with mixed causes.In patients with occult LVOTO,E,A,E/A,and LVEDV were significantly lower,and left ventricular outflow tract velocity and pressure gradient were significantly higher during Valsalva maneuver than at rest(all P<0.05).Conclusion Valsalva maneuver can be used to detect occult LVOTO in patients with atypical chest pain.

关 键 词：VALSALVA动作 不典型胸痛 隐匿性左心室流出道梗阻 左心室流出道 

分 类 号：R542.2[医药卫生—心血管疾病]