Radionuclide Angiographic Assessment of Global and Segmental Left Ventricular Function at Rest and During Exercise After Coronary Artery Bypass Graft Surgery
Radionuclide Angiographic Assessment of Global and Segmental Left Ventricular Function at Rest and During Exercise After Coronary Artery Bypass Graft Surgery
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冠状动脉搭桥手术后静息和运动时整体和节段左心室功能的放射性核素血管造影评估
DOI：
10.1161/01.cir.66.5.972
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发表时间：
1982
期刊：
影响因子：
37.8
通讯作者：
A. Pitt
中科院分区：
文献类型：
--
作者：
Y. Lim;V. Kalff;M. Kelly;P. Mason;P. Currie;R. Harper;S. Anderson;J. Federman;G. Stirling;A. Pitt
应用放射性核素心血管造影术测定20例慢性稳定型心绞痛患者冠状动脉旁路移植术（CABG）前及术后3个月静息及仰卧踏车运动时的左室射血分数（LVEF）。右前斜门控首过技术用于评估LVEF对最大运动的反应（Wmax），而左前斜门控平衡技术用于评估分级次最大运动期间的LVEF和相对LV容积变化。CABG术后静息时，首次通过（60 ± 12% vs 60 ± 12%）和平衡门控（61 ± 13% vs 62 ± 13%）测量的平均LVEF无变化。在Wmax时，术后平均首过LVEF显著高于术前（63 ± 17% vs 53 ± 17%; p < 0.01），Wmax更高（750 ± 182 vs 590 ± 202 kpm/min; p < 0.001），心率-血压乘积更高（302 ± 59 vs 222 ± 57单位; p < 0.001）。同样，采用逐步回归分析，分级运动期间的平衡门控LVEF水平术后显著高于术前（p< 0.001）;在最高分级工作负荷下，术后平均为63 ± 19%，术前为53 ± 17%，工作负荷较高（500 ± 190 vs 417 ± 155; p< 0.05）和更高的心率-血压乘积（271 ± 55 vs 207 53; p< 0.001）。术后运动LVEF的增加是由于次极量运动期间基于计数的收缩末期容积相对于静息值的比值显著降低（术前1.91 ± 1.04;术后1.14 ± 0.46; p< 0.01）。术后运动期间左室射血分数显着下降的五名受试者均存在一处或多处堵塞或狭窄的移植物。本研究通过两种独立的放射性核素技术记录了成功CABG后3个月运动时最大作功能力和心率-血压乘积的改善。
Left ventricular ejection fraction (LVEF) was measured by radionuclide angiography at rest and during supine bicycle exercise before and 3 months after coronary artery bypass graft surgery (CABG) in 20 patients with chronic stable angina. The right anterior oblique gated first-pass technique was used to assess LVEF response to maximal exercise (Wmax), while the left anterior oblique equilibrium-gated technique was used to assess LVEF and relative LV volume changes during graded submaximal exercise. Mean LVEF was unchanged at rest after CABG by both the first-pass (60 12% vs 60 ± 12%) and equilibrium-gated (61 ± 13% vs 62 ± 13%) measurements. At Wmax, mean first-pass LVEF was significantly higher postoperatively than preoperatively (63 ± 17% vs 53 ± 17%; p < 0.01), with a higher Wmax (750 ± 182 vs 590 ± 202 kpm/min; p < 0.001) and higher rate-pressure product (302 ± 59 vs 222 ± 57 units; p < 0.001). Similarly, equilibrium-gated LVEF levels during graded exercise, using stepwise regression analysis, were significantly higher postoperatively than preoperatively (p< 0.001); at the highest graded work load, they averaged 63 ± 19% postoperatively and 53 ± 17% preoperatively, with higher work loads (500 ± 190 vs 417 ± 155; p< 0.05) and higher rate-pressure products (271 ± 55 vs 207 53; p< 0.001). The increase in exercise LVEF after surgery was due to a marked decrease in the ratio, relative to resting values, of counts-based end-systolic volumes during submaximal exercise (preoperative 1.91 ± 1.04; postoperative 1.14 ± 0.46; p< 0.01). The five subjects in whom LVEF decreased significantly during exercise postoperatively all had one or more blocked or stenosed grafts. This study documents, by two independent radionuclide techniques, an improved LVEF during exercise at an increased maximal work capacity and rate-pressure product 3 months after successful CABG.