Left Ventricular Performance During Muscular Exercise in Patients with and without Cardiac Dysfunction
Left Ventricular Performance During Muscular Exercise in Patients with and without Cardiac Dysfunction
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有或无心脏功能障碍患者肌肉锻炼期间的左心室表现
DOI：
10.1161/01.cir.34.4.597
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发表时间：
1966
期刊：
影响因子：
37.8
通讯作者：
E. Braunwald
中科院分区：
文献类型：
--
作者：
J. Ross;J. Gault;D. Mason;J. Linhart;E. Braunwald
对38例患者在仰卧位肌力训练前和训练中分别测定LVEDP、心输出量和Vo 2。在7例无左心室功能障碍的患者中建立的正常模式包括运动因子[见PDF文件中的方程]，运动期间LVEDP小于12 mm Hg，LVEDP几乎没有变化或降低，在大多数情况下伴有每搏输出量增加。在31例患有各种心脏病变但无瓣膜返流的患者中，当左心室状态无法通过其他测量确定时，运动前和运动期间测量LVEDP可定义左心室功能正常或异常。因此，在大多数二尖瓣狭窄和异常静息血流动力学的患者中，运动期间的左心室功能模式被认为是正常的。在主动脉瓣狭窄或左心室心肌疾病和静息LVEDP升高的患者中，确定了两种类型的左心室功能异常。在一些患者中，LVEDP增加伴随着每搏输出量增加，这种反应被称为“左心室动力学异常”;在其余患者中，LVEDP增加，每搏输出量无变化或下降，这种反应被称为“左心室功能下降”。它的结论是，确定运动前和运动过程中的LVEDP增加了重要的心输出量和O2消耗的变化，在表征左心室性能的测量。该方法采用标准的导管插入技术，并似乎提供了一个实用和有用的手段来评价左心室功能状态的患者和没有心肌功能障碍。
The LVEDP, cardiac output, and Vo2 were measured before and during supine muscularexercise in 38 patients. The normal pattern, established in seven patients without left ventricular dysfunction, consisted of an exercise factor[see Equation in PDF file]an LVEDP during exercise of less than 12 mm Hg, and little change or a decrease in LVEDP, which was accompanied in most instances by an increase in the stroke volume. In the majority of 31 patients with various cardiac lesions, but without valvular regurgitation, measurement of the LVEDP before and during exercise permitted the definition of normal or abnormal left ventricular function when the status of the left ventricle could not have been ascertained from other measurements. Thus, in most of the patients with mitral stenosis and abnormal resting hemodynamics, the pattern of left ventricular function during exercise was considered to be normal. Among the patients with aortic stenosis or left ventricular myocardial disease and elevated resting LVEDP, two types of abnormal performance of the left ventricle were identified. In some patients, an increase in LVEDP was accompanied by an increase in stroke volume, and this response was termed “abnormal left ventricular dynamics”; in the remaining patients, an increase in LVEDP and no change or a fall in stroke volume occurred and this response was termed “depressed left ventricular function.” It is concluded that determination of the LVEDP before and during exercise adds importantly to measurements of the changes in cardiac output and O2 consumption in characterizing left ventricular performance. The method employs standard catheterization techniques and appears to provide a practical and useful means for evaluating the functional status of the left ventricle in patients with and without myocardial dysfunction.