Relevance of intraventricular pressure gradients in left ventricular diastolic and systolic function: clinical implications.

心脏病学 医学 内科学 心室 后负荷 心室压 舒张期 狭窄 血压 血流动力学
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Miguel Guerra
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期刊:PubMed 卷期号:25 (1-2): 19-26 被引量:5
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Intraventricular pressure gradients (IVPGs) play a physiological role in normal filling and emptying of the left ventricle. Regional alterations in IVPGs might be an important factor in the characteristic changes that occur in intraventricular flow in specific cardiac disorders and may contribute to and represent an early sign of ventricular dysfunction. Diastolic IVPGs, a marker of normal ventricular filling, and systolic IVPGs, a marker of normal ventricular emptying, can be attenuated, lost entirely or even reversed when ventricular emptying is opposed by afterload elevations, after regional acute ischaemia and in failing hearts. Moreover, in patients with severe aortic valve stenosis showing IVPGs impairment, diastoIic and systolic IVPGs improved after aortic valve replacement. The importance of IVPGs in cardiac function has so far not been entirely evaluated. A proof of the prognostic role or of the ability to identify incipient ventricular dysfunction or lack of functional reserve may help clinical decisions, turning non-invasive IVPGs into useful clinical tools.Os gradientes de pressão intraventriculares (GPIVs) desempenham um papel fisiológico no enchimento e esvaziamento normais do ventrículo esquerdo. Alterações regionais destes gradientes, associadas a perturbações do fluxo intraventricular, podem ser um sinal precoce de disfunção ventricular em distúrbios cardíacos específicos. Os GPIVs observados durante a diástole e durante a sístole podem estar atenuados, suprimidos ou até invertidos em condições de pós-carga aumentada, isquemia regional aguda ou insuficiência cardíaca, representado um marcador do enchimento e esvaziamento ventricular normal, respetivamente. Além disso, em doentes com estenose aórtica severa estes gradientes estão comprometidos ao longo de todo o ciclo cardíaco, mas reaparecem imediatamente após a substituição valvular. A importância clínica dos GPIVs na função cardíaca ainda está por estabelecer, contudo, a identificação de pequenas alterações destes gradientes poderá contribuir para um diagnóstico e intervenção mais precoces em condições que cursam com disfunção ventricular.

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