CORRELATION OF ROENTOGEN KYMOGRAPHIC HEART SIZE AND AORTA CROSS SECTION WITH HEMODYNAMICAL VALUES IN HYPERTENSION

Abstract

With the application of the physical circulatory analysis, it is possible to reveal continuously the hemodynamics of every cardiac circle without psychosomatic interference to patients; in addition, its technique is relative simple and easy. Such points can be appreciated as much as Fick-Cournand (F-C) method, though the principles of two methods are quite different. However, there should be paid some caution to perform Wezler-Boeger's method, among them it has been pointed out by us that the determination of cross-section of aorta in W-B's original method, that is to say, the measurement of Q has some question to be verified, because Prof. Wezler quotes Q from Suter's or Thoma's table established in the case of autopsies.
We have clinically determined Q by the application of X-ray kymography, and reported the liabity of Q thus estimated under the comparative observation of Q measured in the case of autopsies. Details upon these results were published in the congress of the Japanese Angiocardiological Association held in 1955 and 1956.
Q in 500 control cases and in 150 patients suffering from essential hypertension were estimated and the correlation between X-ray kymographical findings of heart and the classification according to both Keith-Wagener and Wezler-Boeger were examined Following results were obtained:
1. Q and age. Comparing with age-curve presented by Suter and by us, our findings are higher in the juvenile and lower in the senile than these of Suter's. This difference may depend upon whether post mortem change in elasticity of vascular wall is to some extent considered or not.
The standard deviation in health is so large, that it may be more reasonable to estimate if it is possible, individually, than to calculate from the averaged value.
In juvenile hypertension, Q in all patients exists within normal range.
In the middle-aged and senile hypertensives, only 23.8% of them show normal value. There can be observed no relationship between K.W.'s classification and Q.
2. Mean arterial pressure and Q. In health, a certain constant correlation can be found, while in hypertensives such a tendency can not be ascertained. In dogs under anesthesia, intracarotid pressure was determined after infusion of the contrast drugs injected into pulmonary vein, and the comparative observation of i. c. Pr and Q disclosed some constant relationship between them as tbl. 7.
3. Height, Weight, Girth of chest and Q.
Q appears to have some relationship with girth of chest, but this tendency becomes more vague regarding weight and height. As to girth of chest there can be seen consi-derable distinct correlation between these values in juvenile hypatension, but no correlation in the middle aged and senile.
4. Calculated weight, calculated girth of chest and Q.
There can be observed fairly significant relationship between these three factors, especially, in the cases under 30 years. That is to say, the fluctuation of Q depends not only upon years but also upon mean blood pressure, calculated weight and calculated girth of chest.
5. With the use of X-kymography, the correlation between calculated values of heart and range of mean blood pressure is studied, with special reference to L, Tr, Br, Fl, Ml: Mr, B-h, r, θ. In the group below 170mmHg there can be found many cases with ± or +, patients with thier blood pressure between 171 and 210mmHg show ±, + and ++ so that the distribution is more equal; above 210mmHg there increase cases + or ++, and seldom those with +++.
6. 20 cases suffering from juvenile hypertension show the 1st type according to K.W.'s classification, the calculated values are -, ± and +, and there can not be found ++.
In 28 cases with senile hypertension, there can be found each type of K.W. in which ±, +, ++ are distributed more equally.
In the middle-age group, there is dominant the K.W.'s 2nd type and + or ++ is found in almost cases.