类风湿关节炎病人血清细胞因子水平以及与炎症指标的相关性

目的：进一步研究细胞因子在类风湿关节炎（ＲＡ）中的作用以及与疾病的关系。方法：随机就诊的７２名门诊及住院ＲＡ病人红细胞沉降率（ＥＳＲ）、Ｃ反应蛋白（ＣＲＰ）以及细胞因子白细胞介素１α（ＩＬ１α）、ＩＬ１β、ＩＬ２、ＩＬ６、肿瘤坏死因子α（ＴＮＦα）、粒细胞单核细胞集落刺激因子（ＧＭＣＳＦ）被测定。全部数据用于ＲＡ病人细胞因子水平的研究，并对细胞因子与炎症指标的相关性进行探讨。结果：ＲＡ病人血清ＧＭＣＳＦ、ＴＮＦα水平较健康对照组明显增高（Ｐ＜０００１）。ＩＬ６、ＧＭＣＳＦ与炎性指标ＥＳＲ（ｒ＝０２６，Ｐ＜００１；ｒ＝０２８，Ｐ＜００２）和ＣＲＰ（ｒ＝０４０，Ｐ＜００００１；ｒ＝０４７，Ｐ＜００００１）呈正相关。结论：ＲＡ病人血清ＩＬ６、ＧＭＣＳＦ、ＴＮＦα较其他细胞因子与ＲＡ疾病有更密切的相关性。细胞因子作为重要的免疫物质参与炎症反应在ＲＡ的病理过程中起到了重要作用。     

正常人群的心率变异性分析

将１００４例正常人分三个年龄组进行短程（５ｍｉｎ）心率变异性（ＨＲＶ）分析。时域法的参数为平均心率标准差（ＨＲＳＤ），连续５ｍｉｎ节段平均正常ＲＲ间期标准差（ＳＤＡＮＮ），相邻ＲＲ间期差的均方根（ｒＭＳＳＤ），相邻ＲＲ间期差异≥５０ｍｓ的百分数（ＰＮＮ_（５０））；频域法的参数为极低频（ＶＬＦ）、低频（ＬＦ）、高频（ＨＦ）成分，总功率（ＴＰ）及ＬＦ／ＨＦ比值。各指标间做相关分析。结果：４５岁以上组ＨＲＳＤ、ＳＤＡＮＮ、ｒＭＳＳＤ、ＰＮＮ_（５０）、ＶＬＦ、ＬＦ、ＨＦ、ＴＰ均低于４５岁以下两组（Ｐ＜０．０５或＜０．０１）。ＳＤＡＮＮ、ｒＭＳＳＤ、ＰＮＮ_（５０）与ＨＦ呈高度正相关（ｒ＞０．７０，Ｐ＜０．０００１），其中以ＳＤＡＮＮ、ＰＮＮ_（５０）相关更好（ｒ＞０．７５，Ｐ＜０．００１），ＳＤＡＮＮ、ｒＭＳＳＤ、ＰＮＮ_（５０）间高度相关（ｒ＞０．８０，Ｐ＜０．０００１）。不同性别ＨＲＶ各参数相比无显著差异。提示：ＨＲＶ随年龄的增长而下降，以迷走神经张力下降为主；各指标中以ＳＤＡＮＮ、ｒＭＳＳＤ、ＰＮＮ_（５０）、ＨＦ能更好地反映迷走神经张力变化。     

ELISA法与DELFIA法测定新生儿TSH的结果分析

目的比较双位点酶免法（Ｔｗｏ－ｓｉｔｅＥＬＩＳＡ）和时间分辨荧光免疫法（ＤＥＬＦＩＡ）测定新生儿ＴＳＨ的结果。方法采用芬兰进口试剂盒测定２１８例足月正常新生儿足血和脐血的成对ＴＳＨ值。结果ＥＬＩＳＡ法和ＤＥＬＦＩＡ法测定的脐血ＴＳＨ值有明显的相关性,其相关系数ｒ＝０．９１（ｔ＝３２．４１,Ｐ＜０．００１）;两种方法测定的足血ＴＳＨ值也有良好的相关性,其相关系数ｒ＝０．７８（ｔ＝１８．４０,Ｐ＜０．００１）;ＥＬＩＳＡ法测定值在足血和脐血间的相关系数却甚低,ｒ＝０．２１（ｔ＝３．１７,Ｐ＜０．０１）;ＤＥＬＦＩＡ法测定值在两者间的相关系数也很低,ｒ＝０．１５（ｔ＝２．２４,Ｐ＜０．０５）。结论ＥＬＩＳＡ和ＤＥＬＦＩＡ两种方法测定的脐血和脐血之间、足血和足血之间均呈现良好的正相关,但两种方法各自测定的脐血和足血之间相关性均不明显     

超声心动图评价法乐氏四联症根治术疗效

目的：探讨超声心动图对法乐氏四联症（ＴＯＦ）根治术疗效的评价。方法：Ｃ地３１例ＴＯＦ根治术患术前及术后一周行超声心动图检查。结果：术后右室流出道（ＲＶＯＴ）、肺动脉（ＰＡ）、左肺动脉（ＬＰＡ）、右肺动脉（ＲＰＡ）内径较术前明显增宽（Ｐ＝０．０００１）,肺动脉瓣最大血流速度（ＰＡＶｍａｘ）肺动脉跨瓣压差（ＰＧ）较术前明显降低（Ｐ＝０．０００１）。结论：ＲＶＯＴ、ＰＡ、ＬＰＡ、ＲＰＡ、ＰＡＶｍａｘ、     

慢性阻塞性肺疾病和肺心病患者血液动力学与循环内皮细胞变化

目的探讨慢性阻塞性肺疾病（ＣＯＰＤ）和肺心病时血循环内皮细胞、血液动力学的变化及意义。方法运用右心导管检查技术和血循环内皮细胞（ＣＥＣ）分离技术，用硫巴比妥法及羟胺法测定血丙二醛（ＭＤＡ）及超氧化物岐化酶（ＳＯＤ）。结果肺心病组肺动脉平均压［（ｍＰＡＰ）３７６±０７５ｋＰａ、血ＣＥＣ数量每０９微升为１６７０±２６５与ＣＯＰＤ组（８４８±２２３）比较，差异有显著性（Ｐ＜０．０１），血ＣＥＣ数量与动脉血氧分压（ＰａＯ２）比较呈显著负相关（ｒ＝０．９４２３，Ｐ＜０．００１），血ＣＥＣ数量与肺动脉压比较呈显著正相关（ｒ＝０．８２７０，Ｐ＜０．００１），肺心病组丙二醛（ＭＤＡ）、超氧化物歧化酶（ＳＯＤ）与ＣＯＰＤ组比较，差异有显著性（Ｐ＜０．０１）。结论缺氧可加重血管内皮细胞损伤     

一氧化氮对缺氧性肺动脉高压大鼠血浆降钙素基因相关肽？…

目的 探讨一氧化氮（ＮＯ）对缺氧性肺动态高压（ＨＰＨ）大鼠血浆降钙素基因相关肽（ＣＧＲＰ）含量的影响。方法 将Ｗｉｓｔａｒ大鼠４０只分为四组：对照组（ｎ＝１０）,缺氧组（ｎ＝１０）,缺氧＋Ｌ－ＮＡＭＥ组（ｎ＝１０）,缺年头＋Ｌ－Ａｒｇ组（ｎ＝１０）。通过Ｐ５０压力传感器测量定四组大鼠肺动脉平均压（ＰＡＭＰ）,缺氧＋Ｌ－Ａｒｇ组的ＰＡＭＰ显著低于缺氧组（Ｐ〈０．０５）;缺氧组的右室（ＲＶ）干重／左室     

风湿性心脏病慢性心房颤动迷宫和二尖瓣手术围术期的血液动力学监测

采用Ｓｗａｎ－Ｇａｎｚ漂浮导管，对１４例同时行迷宫和二尖瓣手术的风湿性心脏病慢性心房颤动（简称房颤）患者在术前和术后２４ｈ、４８ｈ及１个月进行血液动力学监测。结果：①术后２４ｈ、４８ｈ、１个月的心输出量（ＣＯ）、心脏指数（ＣＩ）、每搏指数（ＳＩ）、体循环阻力指数（ＳＶＲＩ）、左室每搏作功指数（ＬＶＳＷＩ）和右室每搏作功指数（ＲＶＳＷＩ）与术前比较差异有显著性（Ｐ＜０．０５～０．０００１）。②心率（ＨＲ）、平均动脉压（ＭＡＰ）、平均肺动脉压（ＭＰＡＰ）、肺动脉毛楔压（ＰＡＷＰ）、中心静脉压（ＣＶＰ）、左心作功指数（ＬＣＷＩ）、肺循环阻力指数（ＰＶＲＩ）、右心作功指数（ＲＣＷＩ）等，术后与术前以及不同时间之间比较均无统计学意义，Ｐ＞０．０５。③ＭＰＡＰ、ＰＡＷＰ、ＣＯ、ＣＩ、ＳＩ、ＳＶＲＩ、ＬＶＳＷＩ的异常发生率术后１个月与术前比较有显著性差异，Ｐ＜０．０５、＜０．０１或＜０．０００１。迷宫术后ＣＯ较术前明显提高，左房压力恢复正常，肺血管压力降低。以上表明风湿性心脏病慢性房颤迷宫和二尖瓣术后ＣＯ、左心功能均有明显改善，无围术期死亡和严重并发症，提示血液动力学监测对及时了解泵功能状态、指导治疗和评价手术疗效是非常?     

高血压病人白细胞流变性与细胞粘附分子表达的变化

目的探讨白细胞流变性和细胞粘附分子（ＣＡＭＳ）表达与高血压发生及病情严重程度的关系。方法采用红细胞变形能力测定仪、体外血栓血小板粘附两用仪和酶联免疫吸附法（ＥＬＩＳＡ），检测１４９例高血压病人和１１０例健康人外周血白细胞变形能力（ＬＤ）、白细胞粘附功能（ＬＡＦ）、白细胞ＣＤ１８表达及血清可溶性细胞间粘附分子－１（ｓＩＣＡＭ－１）浓度的变化。结果高血压病人白细胞滤过指数（ＬＦＩ）、白细胞粘附率（ＬＡＲ）、白细胞ＣＤ１８表达和ｓＩＣＡＭ－１浓度均明显增高，与对照组比较差异有极显著性（Ｐ＜０．００１），三期病人各指标之间比较差异也具有极显著性（Ｐ＜０．００１），且以第３期病人各指标增高最明显。高血压病人ＬＡＲ与ＬＦＩ呈正相关（ｒ＝０．５７９，Ｐ＜０．００１）；ＬＡＲ和ＬＦＩ与白细胞ＣＤ１８表达和ｓＩＣＡＭ－１浓度呈正相关（ｒ＝０．６６２～０．８０４，Ｐ＜０．００１）。结论ＬＤ降低、ＬＡＦ及白细胞ＣＤ１８表达和ｓＩＣＡＭ－１浓度增高参与高血压的发生，且与病情严重程度有密切关系。     

用IRMA法和ELISA法检测同批新生儿脐血TSH的结果比较

以ＩＲＭＡ和ＥＬＩＳＡ两种方法检测足月产正常新生儿脐血２６４份，结果：９６．２％的样品检测值为ＩＲＭＡ＞ＥＬＩＳＡ，其Ｍ±Ｓｍ分别为７．６４±０．２７ｍＩＵ／Ｌ和４．０７±０．２５ｍＩＵ／Ｌ，（ｕ＝９．７０，Ｐ＜０．０１）；ＴＳＨ值＜５ｍＩＵ／Ｌ的百分率分别为２２．１％和６１．４％，（ｕ＝２．１４，Ｐ＜０．０５）；经配对比较，两法呈现良好的正相关关系，ｒ＝０．７０６（ｔ＝１６．１２，Ｐ＜０．０００５）。根据本实验求得以ＥＬＩＳＡ检测值推算ＩＲＭＡ值的直线回归方程式是：Ｙ＝３．５９９５＋１．０４８０Ｘ。作者认为：用国产ＩＲＭＡ纸片法试剂盒检测新生儿脐血ＴＳＨ时，其上限值可界定在≤９ｍＩＵ／Ｌ。     

慢性低氧性肺动脉高压的无创诊断

通过Ｓｗａｎ－Ｇａｎｚ导管，测定了３０例ＣＯＰＤ并肺心病患者的肺动脉压等血流动力学参数，同步行核素心功能、超声心动图、血气分析、肺功能等检查。结果发现肺动脉平均压（ｍＰＡＰ）与右室射血分数（ＲＶＥＦ）、残气／肺总量（ＲＶ／ＴＬＣ）、肺动脉直径（ＰＣＤ）、动脉血氧饱和度（ＳａＯ２）等均有显著相关性（Ｐ均＜０．０５）。通过逐步回归分析得到最优多元回归方程：Ｙ（ｍＰＡＰ）＝３．９０２－０．１０６ＲＶＥＦ＋０．０３６ＲＶ／ＴＬＣ＋０．２００ＰＡＤ－０．０５０ＳａＯ２。该多元回归方程可试用于临床低氧性肺动脉高压的无创诊断。     

Value of two-dimensional echocardiography in the identification of pulmonary hypertension in chronic obstructive lung disease

Thirty-three patients suffering from chronic obstructive lung disease (COLD) were submitted to right heart two-dimensional echocardiographic (2D-ECHO) and hemodynamic study. By the subcostal approach, the right ventricle outflow tract including the pulmonary vessels was visualized in 85% of the patients. Most parameters measured on the right ventricle and pulmonary vessels were significantly higher than those recorded in the healthy control group. Very significant correlations were observed between the mean pulmonary artery pressure (PAP) and the following 2D-ECHO parameters: diameter of the pulmonary artery at valve level (r = 0.62; p less than 0.001); supravalvular diameter of the pulmonary artery (r = 0.44; p less than 0.03); diameter of the left branch of the pulmonary artery (r = 0.48; p less than 0.05); diameter of the right branch of the pulmonary artery (r = 0.39; p less than 0.05), and between the PAP and PaO2 (r = -0.66; p less than 0.001). Furthermore, the sensitivity, specificity, and accuracy of 2D-ECHO measurements were calculated to assess the presence of pulmonary hypertension. Overall sensitivity was 65%, specificity 75%, and accuracy 67%. However, by combining the value of PaO2 with that of the pulmonary valve by means of the multiple regression analysis, sensitivity increased to 84% in identifying pulmonary hypertension. Such data demonstrate that the 2D-ECHO study of the right heart in COLD patients has to carefully measure the dimensions of the pulmonary valve and the great pulmonary vessels, as their modification are mainly linked with the presence of pulmonary hypertension.(ABSTRACT TRUNCATED AT 250 WORDS)     

The relationship between ventilatory lung motion and pulmonary perfusion shown by ventilatory lung motion imaging

Using ventilatory lung motion imaging, which was obtained from two perfusion lung scintigrams with 99mTc-macroaggregated albumin taken in maximal inspiration and maximal expiration, the lung motion [E-I)/I) of the each unilateral lung was studied in various cardiopulmonary diseases. The sum of (E-I)/I(+) of the unilateral lung showed a decrease in the diseased lung of localized pleuropulmonary diseases, including primary lung cancer and pleural thickening, and in both lungs in cases of heart diseases, diffuse pulmonary diseases including diffuse interstitial pneumonia and diffuse panbronchiolitis. The sum of (E-I)/I(+) of the both lungs, which correlated with vital capacity and PaO2, showed a decrease in diffuse interstitial pneumonia, pulmonary emphysema, diffuse panbronchiolitis, primary lung cancer, pleural diseases and so on. (E-I)/I(+), correlated with pulmonary perfusion (n = 49, r = 0.51, p less than 0.001), but not a few cases showed mismatch, which was observed in primary lung cancer, pleural diseases, pulmonary emphysema, diffuse panbronchiolitis and so on. (E-I)/I(+) better correlated with pulmonary ventilation by ventilation scintigraphy with 81mKr or 133Xe (n = 49, r = 0.61, p less than 0.001) than pulmonary perfusion. The ventilatory lung motion imaging, which demonstrates the motion of the intra-pulmonary areas and lung edges, appears useful for estimating pulmonary ventilation of the perfused area as well as pulmonary perfusion.     

The efficacy of using pulmonary vein wedge pressure for the estimation of pulmonary artery pressure in children with congenital heart disease.

The objectives of this study were to assess the accuracy of pulmonary vein wedge pressure (PVWP) in estimating pulmonary artery pressure (PAP) in various types of congenital heart disease, including single-ventricle physiology. The systolic, diastolic, and mean values of both PAPs and PVWPs were measured in 30 patients (a total of 46 points). Pulmonary artery pressure ranged from 13 to 74 (34 +/- 15) mm Hg in systole, 5 to 25 (13 +/- 6) mm Hg in diastole, and 6 to 48 (18 +/- 10) mm Hg in mean. As a whole, good correlations between PAPs and PVWPs were observed (systole, r = 0.70; diastole, r = 0.85; mean, r = 0.82; P < 0.0001). However, with an increase in PAP, the discrepancy between PAPs and PVWPs increased. When the mean PVWP was more than 18 mm Hg, the mean PVWP in 14 of 24 (58%) underestimated the mean PAP by up to 22 mm Hg (mean difference, -1.7 +/- 5.8 mm Hg). On the other hand, all of the patients with mean PVWPs less than 18 mm Hg (n = 22) had mean PAPs less than 18 mm Hg (r = 0.86; PAP = 1.11 x PVWP - 1.41; P < 0.0001), and the mean difference was -0.2 +/- 1.8 mm Hg. The mean PVWP can accurately estimate the mean PAP in children with congenital heart disease who have a mean PVWP less than 18 mm Hg.     

Evaluation of Tl-20 lung uptake and impairment of pulmonary perfusion on scintigraphies in pulmonary tuberculosis

Tl-201 lung uptake in 74 patients (85 lesions) and pulmonary perfusion in 105 patients were studied to evaluate clinical usefulness of Tl-201 lung uptake and perfusion lung scintigraphy in pulmonary tuberculosis, using a scintillation camera with a mini-computer system. As indices of Tl-201 lung uptake, lung (lesion) to upper mediastinum uptake ratio (L/M) and visual grading were used. L/M in pulmonary tuberculosis was 1.96 +/- 0.66, which was significantly larger than 1.04 +/- 0.24 in healthy controls and lower than that in heart diseases with left heart failure and idiopathic interstitial pneumonia, and showed no significant differences with that in acute pneumonia, pyothorax, primary lung cancer and malignant mediastinal tumor. L/M in pulmonary tuberculosis did not correlate with CRP, erythrocyte sedimentation rate, Gaffky number of sputum and body temperature. It correlated with the type of pulmonary tuberculosis according to the Gakken Classification reflecting the disease activity. It was larger in the exudative type, caseo-infiltrative one, disseminated one, one with cavity in infiltrative lesion than the fibro-caseous one. On perfusion lung scintigram, impairment of pulmonary perfusion larger than area of the entire unilateral lung was observed in 68 cases (64.8%). Area of hypoperfused lung field, which correlated with % vital capacity (r = 0.60, p = 0.0002) and PaO2 (r = 0.39, p = 0.0024), was significantly larger in patients with silicosis and those with bilateral pleural involvements such as pleural callosity than in those with type III according to the Gakkai Classification. Most of the patients showed decreased pulmonary perfusion and Tl-201 accumulation of which grade reflects the disease activity in active tuberculous lesion. Patients with miliary tuberculosis and those with silicotuberculosis showed diffuse Tl-201, accumulation in the both lungs. Tl-201 lung scintigraphy seems to be useful for visualizing active tuberculous lesions, particularly the ones that could not be detected by the chest radiograph in patients with destroyed lung and with pleural callosity. Joint use of Tl-201 and perfusion lung scintigraphies provides useful informations about the pathophysiology and disease process in pulmonary tuberculosis.     

Regional pulmonary blood flow in mitral disease studied by xenon radiospirometry.

Regional lung perfusion was measured in the sitting position by 4 external detectors after intravenous injection of 133Xe in 24 patients with mitral valve disease and in 8 people with no cardiopulmonary disease acting as normal controls. Right- and left-sided heart catheterization was carried out on the patients on the following day. Mitral valve stenosis was found in 9, mitral valve regurgitation in 8, and both stenosis and regurgitation in the remaining 7. Regional lung perfusion in the normal people fell linearly from the basal to the apical sections of the lungs. The perfusion distribution in patients with mitral valve disease and a pulmonary capillary vein (PCV) pressure lower than 15 mmHg (2-0 kPa) did not differ significantly from that of the controls. A redistribution of the regional perfusion, with an increase in the apical perfusion and a fall in the basal perfusion of the lungs, was seen in patients with a raised PCV pressure. The hyperperfusion of the apical lung sections correlated with the mean pressure in the pulmonary artery (r=+0-795, P less than 0-001), while the basal hypoperfusion correlated with the PCV pressure (r=0-842, P less than 0-001). The PCV pressure can be predicted with an exactitude of +/- 7 mmHg (0-9 kPa) (95% confidence limits). Neither the cardiac index nor the pulmonary vascular resistance correlated with the changes in perfusion. Xenon radiospirometry is a rapid and reliable method for evaluating PCV pressure before or after operation in patients with mitral valve disease.     

Regional pulmonary blood flow in mitral disease studied by xenon radiospirometry.

Regional lung perfusion was measured in the sitting position by 4 external detectors after intravenous injection of 133Xe in 24 patients with mitral valve disease and in 8 people with no cardiopulmonary disease acting as normal controls. Right- and left-sided heart catheterization was carried out on the patients on the following day. Mitral valve stenosis was found in 9, mitral valve regurgitation in 8, and both stenosis and regurgitation in the remaining 7. Regional lung perfusion in the normal people fell linearly from the basal to the apical sections of the lungs. The perfusion distribution in patients with mitral valve disease and a pulmonary capillary vein (PCV) pressure lower than 15 mmHg (2-0 kPa) did not differ significantly from that of the controls. A redistribution of the regional perfusion, with an increase in the apical perfusion and a fall in the basal perfusion of the lungs, was seen in patients with a raised PCV pressure. The hyperperfusion of the apical lung sections correlated with the mean pressure in the pulmonary artery (r=+0-795, P less than 0-001), while the basal hypoperfusion correlated with the PCV pressure (r=0-842, P less than 0-001). The PCV pressure can be predicted with an exactitude of +/- 7 mmHg (0-9 kPa) (95% confidence limits). Neither the cardiac index nor the pulmonary vascular resistance correlated with the changes in perfusion. Xenon radiospirometry is a rapid and reliable method for evaluating PCV pressure before or after operation in patients with mitral valve disease.     

CT scan findings in chronic thromboembolic pulmonary hypertension: predictors of hemodynamic improvement after pulmonary thromboendarterectomy

STUDY OBJECTIVES: The aim was to correlate CT scan findings with hemodynamic measurements in patients who had undergone pulmonary thromboendarterectomy (PTE) and to evaluate whether CT scan findings can help to predict surgical outcome.Patients and method: Sixty patients who underwent PTE and preoperative helical CT scanning were included. Preoperative and postoperative hemodynamics were correlated with preoperative CT imaging features. RESULTS: The diameter of the main pulmonary artery (PA) and the ratio of the PA and the diameter of the ascending aorta correlated with preoperative mean pulmonary artery pressure (PAP) [r = 0.42; p < 0.001; and r = 0.48; p < 0.0001, respectively]. There was a significant correlation of subpleural densities with preoperative pulmonary vascular resistance (PVR) [r = 0.44; p < 0.001] and of the number of abnormal perfused lobes with preoperative PAP (r = 0.66; p < 0.0001) and PVR (r = 0.76; p < 0.0001). Postoperative PVR correlated negatively with the presence and extent of central thrombi (r = -0.36; p = 0.007) and dilated bronchial arteries (p = 0.03) seen on preoperative CT scans. Sixty percent of patients (3 of 5 patients) without visible central thromboembolic material on CT scans had an inadequate hemodynamic improvement in contrast to 4% of patients (2 of 51 patients) with central thrombi (p = 0.003). Preoperative PVR (r = 0.31; p = 0.018) and the extent of abnormal lung perfusion (r = 0.37; p = 0.007) and of subpleural densities (r = 0.32; p = 0.017) were positively correlated with postoperative PVR. CONCLUSIONS: In patients with thromboembolic pulmonary hypertension, CT scan findings can help to predict hemodynamic improvement after PTE. The absence of central thrombi is a significant risk factor for inadequate hemodynamic improvement.     

Feasibility of generating hemodynamic pressure curves from noninvasive Doppler echocardiographic signals

Objectives. This study was designed to determine the feasibility of Doppler generation of accurate, complete right ventricular and pulmonary artery pressure curves in patients with Dopplermeasurable tricuspid and pulmonary regurgitation.Background. Doppler-derived flow velocities have been used to assess right ventricular systolic pressure; pulmonary artery systolic, diastolic and mean pressures, and left ventricular systolic and diastolic pressures. Instantaneous gradient across any area of discrete narrowing is accurately derived using the simplified Bernoulli equation (4V²). Invasive catheterization is currently the only means of generating intracardiac pressure curves. Noninvasively derived pressure curves using Doppler echocardiography would be a considerable advance in the assessment of normal and pathologic cardiac hemodynamics.Methods. Right ventricular and pulmonary artery pressure curves were generated in 18 of 22 patients with measurable tricuspid and pulmonary valve regurgitation using superimposition of Doppler-measured tricuspid and pulmonary valve blood flow velocities on an assumed right atrial pressure. Dopplermeasured right ventricular and pulmonary artery pressure curves were compared with simultaneous catheterization-measured curves.Results. Doppler-derived pulmonary artery systolic pressure (Doppler PAP) correlated with simultaneous catheter-measured pulmonary artery pressure (Cath PAP) by the equation Doppler PAP = 0.92(Cath PAP) + 4.5, r = 0.98. Other Doppler-derived pressure measurements that correlated at near identity with the catheterization-measured corresponding measurement include Doppler-derived pulmonary artery mean pressure (Doppler mean PAP) [Doppler mean PAP = 0.85(Cath mean PAP) + 2.6, r = 0.97], and Doppler-derived right ventricular pressure (Doppler RVP) [Doppler RVP = 0.84(Cath measured RVP) + 7.9, r = 0.98]. Doppler-derived pulmonary artery diastolic pressure (Doppler PAP diast) did not correspond as well in this study [Doppler PAP diast = 0.45(Cath PAP diast) + 6.6, r = 0.83].Conclusions. Clinically usable right ventricular and pulmonary artery pressure curves can be derived by superimposing Dopplermeasured tricuspid and pulmonary valve blood flow velocities in patients with tricuspid and pulmonary valve regurgitation.     

Influence of left ventricular function and severity of coronary artery disease on exercise-induced pulmonary thallium-201 uptake

Pulmonary uptake of thallium-201 during exercise was measured in 58 patients with coronary artery disease and compared with the results from 21 patients with normal coronary arteries and 5 normal volunteers. A quantitative method was used to assess the pulmonary thallium uptake relative to cardiac activity (heart/lung ratio). This ratio was calculated for exercise and for redistribution imaging. The mean exercise heart/lung ratio for the group with coronary artery disease was 1.43 +/- 0.36 SD (n = 58); and for the "normal" group was 2.76 +/- 0.41 (n = 26) (P less than 0.001). Increased pulmonary uptake after exercise in the coronary disease group was reversible (mean redistribution heart/lung = 1.96 +/- 0.37 SD; P less than 0.001). The exercise heart/lung ratio differed significantly between groups with single-, two- and three-vessel disease; patients with and without prior infarction; and patients with exercise-induced ST segment depression and elevation. Linear regression analysis between ejection fraction calculated from equilibrium radionuclide angiography at rest and the exercise heart/lung ratio in the coronary artery disease group gave the equation: exercise heart/lung = 0.857 +/- 0.014 ejection fraction for n = 58; r = 0.695; P less than 0.001. It would appear that the exercise heart/lung ratio is a simple and valuable non-invasive index which should be used as part of routine thallium scan interpretation to provide additional information on left ventricular function after exercise and as an indicator of the severity of obstructive coronary artery disease.     

The pulmonary venous wedge pressure in pulmonary arterial hypertension

The comparability of the main pulmonary artery pressure (PAP) and the pulmonary venous wedge pressure (PVWP) was assessed during cardiac catheterization in 89 patients with pulmonary artery hypertension (PAH) and increased pulmonary blood flow. Preliminary evaluation revealed a wide disparity between the 2 determinations. Fifty-five pull-back pressure recordings from branch-to-main pulmonary artery were analyzed. Twenty-four percent (13/55) had systolic pressure gradients >20 mm Hg. between branch and main pulmonary artery. When PVWP and only ipsilateral branch PAP were compared (n=48), diastolic and mean (m), but not systolic PVWP, correlated closely with branch PAP (r=0.77, r=0.73 and r=0.59, respectively). In 46 of 48 patients the PVWP_m was not significantly greater than the ipsilateral PAP. Twenty-nine of 30 patients with PVWP_m <30 mm Hg. had an ipsilateral PAP_m <40 mm Hg. In 15 patients with PVWP_m between 30 and 39 mm Hg, there was a wide range (30–59 mm Hg) of PAP_m. Three patients with PVWP_m >40 mm Hg. had severe PAH. It is concluded that: 1) hemodynamically significant branch-to-main PAP gradients are present in some patients with PAH and may result in erroneously high pulmonary arteriolar vascular resistance when calculated from main PAP; 2) properly performed PVWP determination can define the lower limit of mean pressure in the ipsilateral branch pulmonary artery; 3) a PVWP_m <30 mm Hg. usually indicates an ipsilateral PAP_m <40 mm Hg; 4) a PVWP_m >30 mm Hg. is compatible with either moderate or severe PAH; 5) correlation of PVWP with PAP is not related to pulmonary blood flow.