多普勒血流图评价舒张期心音的血流动力学机制

Study on the Hemodynamic Mechanism of Diastoiic Heart Sounds by Doppler Echocardiography

同步描记心音图及左、右心室充盈血流的多普勒频谱发现:第三心音(S_3)与舒张早期充盈波(E)的波峰同步。第四心音(S_4)起始于舒张晚期心房收缩充盈波(A)的起点,早于 A 峰约50ms,但 S_1的最大振幅与 A 峰同步。结果表明 S_3与 S_4均不产生于心室充盈波的终点,而与相应充盈波的快速充盈期的终点时相一致。配合左、右心室血流探查可区别 S_3、S_4的心室起源。

Phonocardiograms and pulse Doppler filling waves of left ventricle(LV)and right ventricle (RV)were simultaneously recorded in eighty subjects(aged 7—75 years).The onset of the first vi- bration of the third heart sound(S_3),either physical or Pathological,coincided with the peak of the early diastolic filling wave(EP).The onset of the fourth heart sound(S_4)coincided with the begin ning of atrial filling wave(A)and Preceded the peak of A wave(AP)by about 50 ms,but the largest amplitude of vibration of S_4 appeared synchronously with AP.Neither S_3 nor S_4 occurred at the end of the ventricular filling wave,but simultaneusly with the end of the quickfilling of responsible waves.It was suggested that a force making early diastolic filling to sudden deceleraion induced S_3. But both increased atrial contraction and the force similar to that inducing S_3 contributed to genesis of S_4. Analyses of the relation between the heart sounds and LV and RV filling waves might be able to identify the genesis of S3 and S4 when bilateral ventricular filling was not simultaneous.