2004 12 16

2 1 3 2 5 2.1............... 5 2.2........... 14 2.3........................... 17 3 22 3.1.................. 22 3.2......................... 22 3.3........................ 25 3.4........................ 31 3.5...................... 34

3 1 dp/dt 1200mmHg/sec 800mmHg LV-TEI 0.38 0.04 0.45 21ml/m 2 28ml/m 2 PA A 30msec 60cm/sec E DcT 255msec (S) (S) (D) (Systolic filling fraction) 55% 8mmHg 50% 8mmHg

4 1 pulmonary acceleration time 120msec meanpa = 79 0.45 pulmonary acceleartion time E decelration time 130 msec 18mmHg D decelration time 160 msec 18mmHg A A 20msec 95% 12mmHg

5 2 2.1 M EF M 2.1.1

6 2 2.1 E/A E DcT *1 DcT E/A 2.1.2 2.2 S D A 3 *1

2.1 7 S D A ( 2.2) S S1 S2 ( 2.3) 2.3 S D ( 2.4) 2.4 E/A D (PV- DT *2 ) (P.21 ) A *2 160-240 msec

8 2 A A (PVA ) (A ) 30msec 2.1.3 dp/dt 2 2 +dp/dt ( 2.5) 1m/s 3m/s t +dp/dt = (4 32 4 12)/t = 32/t 2.5 t=40msec +dp/dt 800mmHg/sec dp/dt ( 2.6)

2.1 9 2.5 +dp/dt = (4 32 4 12)/t = 32/t t=0.04msec +dp/dt 800mmHg/sec 2.6 dp/dt 615mmHg/sec 2.1.4 M 1. 4

10 2 2. M 3. 45 55cm/sec 4. M ( 2.7) 2.7 (188cm/sec) (48cm/sec) 2.7, 60cm/sec 2.1.5 TEI ( )! ( A )! TEI

2.1 11 2.8 TEI (a-b)/b TEI 2.9 TEI 2.9 TEI ( 0.38 ) TEI a a b b (ET) b a (ICT) (IRT) a b b ICT IRT ET

12 2 (a-b) b TEI a b b TEI TEI 2.1 2.1 TEI (LV) 0.38 0.04 LV-TEl 0.45 0.45 LV-TEI 0.60 0.60 LV-TEI 0.80 0.80 LV-TEI 1.0 1.00 LV-TEI (RV) 0.28 0.04 RV-TEI 0.40 0.40 RV-TEI 0.55 0.55 RV-TEI 0.70 0.70 RV-TEI 0.90 0.90 RV-TEI 2.1.6

2.1 13 2.10 LAD 4 2 area-length 4 2 2 ( 2.10) Schiller 21ml/m 2 *3 *3

14 2 28ml/m 2 89% 86% 32ml/m 2 100% 67% 321 2 *4 32ml/m 2 EF 32ml/m 2 27 1 EF 40% 32ml/m 2 55 22 2.2 pulmonary acceleration time *4 1ml 5%

2.2 15 2.2.1 2.11 d 2.2.2 (TVI) ( 2.12) 2.12 ( ) TVI

16 2 (cm/sec) cm 1 cm / 2.2.3 2.13 ( 2.13) pulmonary acceleration time( 2.14) 120ms (P.19 ) 2.14 pulmonary acceleration time

2.3 17 2.3 2.3.1 2.15 2.15 2 (S) (S) (D) (Systolic filling fraction) 55% 8mmHg *5 ( 86% 90%) 2.16 *5 Circulation. 1996;93:1160-1169

18 2 20mm 10mmHg 25mm 18mmHg 50% 8mmHg ( 72% 76%) 2.3.2 1 CO = VT I ( ) (d)( 2.11) (VT I: ) *6 ( 2.12) = 1/4 πd 2 VT I *6

2.3 19 VT I CO = VT I 2.3.3 PAS P = + pulmonary acceleration time 120ms *7 meanpa = 79 0.45 pulmonary acceleartion time 2.17 130msec 40msec 79 0.45 130 20.5mmHg 61mmHg 2.3.4 *8 *7 Am J Cardiol 1987 Mar 1;59(6):662-8 *8 J Am Coll Cardiol 1999;34:515-23

20 2 2.17 pulmonary acceleration time (IRT) ( 2.18) ( 2.8) M ( 2.7) 2 IVRT msec FPV cm/sec 1000 (2 IVRT) + FPV 5.5 18mmHg 4.5 1000 (mmhg) = (2 IVRT) + FPV 9 2.18 4.5 1000 (mmhg) = (2 55) + 90 9 13.5mmHg 28.8mmHg

2.3 21 2.18 13.5mmHg 28.8mmHg study E (decelration time ) 130 msec 18mmHg 86% D decelration time 160 msec 97% 96% 18mmHg A A 20msec 95% 12mmHg

22 3 3.1 MRII 4 ( ) 3.2 3.2.1 ( 3.1)

3.2 23 3.1 1.5 cm 2 3.2.2 pressure half time pressure half time (PHT) - 1/2 *1 60 msec MS 150 msec MS 220/pressure hal f time(msec) pressure half time PHT AR PHT MR *1 70

24 3 3.2.3 Y Y? MVA>1.5cm 2? - N Y MVA>1.5cm 2? N N - PTMC? PTMC Y N 1 PTMC PTMC MVR PTMC 60mmHg 25mmHg 3 15mmHg 50mmHg 20mmHg PTMC PTMC 1. NYHAII III 2. 1cm 2 3. ( )

3.3 25 PTMC *2 3.3 vena contracta PISA 3.3.1 / 3.3.2 1 1 ( 3.2) *2

26 3 = TVI TVI 3.2 140ml 70% 1 60ml 55% 3.3.3 vena contracta vena contracta ( 3.3) 3.3 vena contracta

3.3 27 P.28 vena contracta 5mm 3.3.4 PISA PISA PISA ( 3.4) 3.4 PISA PlSA PISA

28 3 r(mm) *3 (ERO) *4 ERO = 2πr 2 alias velocity/mr velocity = ERO MR TVI 40cm/sec PISA 10mm 5m/sec ERO = 2π10 2 40/500 = 50.24(mm 2 ) a a *3 4πr 2 PISA 2πr 2 *4 AS

3.3 29 ( ) 20-40cm/sec PISA (mm) TVI(cm/sec) 40cm/sec MR 5m/sec ERO(mm 2 ) 0.5r 2 ERO 0.4cm 2 60ml 3.3.5 S ( 3.5)

30 3 3.5 A S B S D 3.3.6 NYHA I-II NYHA III - IV Y Y? /? N N EF0.60 1 LVDd 45mm Y? N EF 0.30? Y N MVR

3.4 31 1.5 2 LVDs PA Af 0 35mm 60% 35mmHg 0.5 35 45mm 50 60% 35 55mmHg 1 45mm 50% 55mmHg 3.4 0.1 0.3cm 2 / 10 15mmHg/ 3.4.1 50mmHg 50 90mmHg 90mmHg 25mmHg 25 50mmHg 50mmHg AR AR

32 3 20-30mmHg 3.4.2 1 2mm ( 3.6) 3.6 3.4.3 ( 3.7) (AVAcm 2 )

3.4 33 3.7 (AV-TVI cm) (LVOTcm 2 ) (LVOT-TVI cm) AVA = LVOT (LVOT TVI/AV TVI) 3.4.4 90mmHg 50mmHg 0.75cm 2 1. 2. 3. 1. 2. ( ) (IVST 15mm ) 0.6cm 2

34 3 3.5 3.5.1 3.5.2 pressure half time pressure half time 600msec 1100msec 600 1100msec AR AR AR PHT PHT 3.5.3 vena contracta (vena contracta) 3.8 vena contracta

3.5 35 3mm AR 2 ( 3.8) 6mm 3.5.4 PISA PISA ERO 0.3cm 2 3.5.5 EF LVDd LVDs LVDd<70 LVDs <50 LVDd 70-75 LVDs 50-55 LVDd>75 LVDs >55 1 4 2 1. 2. 3. EF55% 4. 1. LVDs 55mm 2. EF50%

36 3 3. 8METs 4. 18