Doppler echocardiographic evaluation of left ventricular diastolic function after percutaneous transluminal coronary angioplasty for unstable angina pectoris or acute myocardial infarction.
Doppler echocardiographic evaluation of left ventricular diastolic function after percutaneous transluminal coronary angioplasty for unstable angina pectoris or acute myocardial infarction.
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多普勒超声心动图评估经皮腔内冠状动脉成形术治疗不稳定心绞痛或急性心肌梗死后左心室舒张功能。
DOI：
10.1016/0002-9149(90)91424-5
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发表时间：
1990
期刊：
影响因子：
--
通讯作者：
Nixon,JV
中科院分区：
文献类型：
--
作者：
Snow,FR;Gorcsan3rd,J;Lewis,SA;Cowley,MJ;Vetrovec,GW;Nixon,JV
经皮冠状动脉腔内成形术 (PTCA) 对左心室 (LV) 舒张功能的影响尚未在急性心肌梗死 (AMI) 后因不稳定心绞痛或缺血治疗的患者中进行系统研究。为了评估这种情况下狭窄严重程度减轻和舒张功能改善之间的关系，42 名患有不稳定型心绞痛 (n = 22) 或 AMI 后缺血 (n = 20) 的患者在 PTCA 前 8±5 小时和术后 2±1 天通过多普勒超声心动图进行了连续监测。多普勒左心室充盈指标包括等容舒张时间、二尖瓣减速时间、E A 峰值速度比和心房充盈分数。十八名年龄匹配的对照受试者用于建立用于比较的正常值。 PTCA前，两组均表现出舒张功能异常，表现为等容舒张时间和二尖瓣减速时间延长、EA比值降低和心房充盈分数增加。 PTCA 后，不稳定心绞痛组等容舒张时间和减速时间分别减少 18±28 (p< 0.005) 和 33±43 ms (p< 0.002)，AMI 后缺血组分别减少 18±23 (p< 0.003) 和 14±34 ms（差异不显着）。两组的 E A 比率均增加，心房充盈分数降低；然而，这些变化仅在 AMI 后缺血患者中才显着（分别为 + 21%，p < 0.03 和− 11.4%，p < 0.005）。早期梗死血管PTCA（定义为AMI后14天内，n=10）与左室充盈改善相关，表现为EA比率增加（1.1±0.4至1.4±0.9，p<0.05）和心房充盈分数降低（41±7至35±10，p<0.02），而这在后期血运重建中未见。因此，严重缺血患者血运重建后 2 天，PTCA 就可以显着改善左室充盈的多普勒指数。在 AMI 后复发性缺血的情况下，早期 PTCA 可能会改善左心室充盈特性。
The effect of percutaneous transluminal coronary angioplasty (PTCA) on left ventricular (LV) diastolic function has not been systematically investigated in patients treated for unstable angina or ischemia after acute myocardial infarction (AMI). To assess the relation between reduction of stenosis severity and improvement in diastolic function in this setting, 42 patients with either unstable angina (n= 22) or post-AMI ischemia (n= 20) were serially monitored by Doppler echocardiography 8±5 hours before and 2±1 days after PTCA. Doppler LV filling indexes included isovolumic relaxation time, mitral deceleration time, E A peak velocity ratio and atrial filling fraction. Eighteen agedmatched control subjects served to establish normal values for comparison. Before PTCA, both groups exhibited abnormal diastolic function demonstrated by prolonged isovolumic relaxation time and mitral deceleration time, decreased E A ratio and increased atrial filling fraction. After PTCA isovolumic relaxation time and deceleration time decreased 18±28 (p< 0.005) and 33±43 ms (p< 0.002) in the unstable angina group and 18±23 (p< 0.003) and 14±34 ms (difference not significant), respectively, in the post-AMI ischemia group. An increase in E A ratio and a decrease in atrial filling fraction occurred in both groups; however, these changes were significant only in patients with post-AMI ischemia (+ 21%, p< 0.03 and− 11.4%, p< 0.005, respectively). Early infarct vessel PTCA (defined as within 14 days of AMI, n= 10) was associated with improvement in LV filling reflected by increased E A ratio (1.1±0.4 to 1.4±0.9, p< 0.05) and decreased atrial filling fraction (41±7 to 35±10, p< 0.02) not seen with later revascularization. Thus, PTCA may produce significant improvement in Doppler indexes of LV filling as early as 2 days after revascularization in patients with severe ischemia. In the setting of recurrent ischemia after AMI, an opportunity may exist during which early PTCA can lead to improvement in LV filling characteristics.
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