The pacing stress test reexamined: correlation of pacing-induced hemodynamic changes with the amount of myocardium at risk.
The pacing stress test reexamined: correlation of pacing-induced hemodynamic changes with the amount of myocardium at risk.
复制标题
重新检查起搏压力测试：起搏引起的血流动力学变化与危险心肌数量的相关性。
DOI：
10.1016/s0735-1097(84)80286-7
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发表时间：
1984
影响因子：
24
通讯作者：
Grossman,W
中科院分区：
文献类型：
--
作者：
McKay,RG;Aroesty,JM;Heller,GV;Silverman,KJ;Parker,JA;Als,AV;Come,PC;Kolodny,GM;Grossman,W
为评价缺血程度与血流动力学变化幅度之间的关系，对25例患者（5例冠状动脉正常，20例严重冠状动脉阻塞性疾病）进行了心导管检查时快速心房起搏和铊心血管造影研究。在最大起搏之前、期间和之后测量血流动力学变量。在最大起搏期间静脉注射铊，并立即在导管室中获得三个标准视图的扫描，在起搏停止后4小时获得延迟扫描。三个铊扫描每个细分为五个部分，并获得了铊分数的基础上的总数量的部分是低灌注。每名患者被分配一个总的铊分数，对应于最大起搏时的铊缺陷，以及一个再分布的铊分数，对应于最大起搏时的铊分数与4小时后的铊分数之间的差异。起搏后，冠状动脉正常的患者表现出基线血流动力学变量没有显著变化，而冠状动脉疾病的患者表现出心脏指数下降，全身血管阻力增加、动静脉氧差扩大、最大起搏期间肺毛细血管楔压和平均肺动脉压增加以及起搏后即刻左心室舒张末期压增加。在起搏后阶段，重分布铊评分与左心室舒张末期压升高之间存在显著相关性（斯皮尔曼等级r = 0.64，p < 0.01）。此外，有一个更高的相关性（斯皮尔曼等级r = 0.90，p < 0.001）之间的总铊评分和起搏后增加舒张末期pressure.It的结论是，在冠心病患者的起搏引起的血流动力学变化的幅度反映了心肌组织缺血的危险和低灌注心肌在最大起搏应力的总质量。
To assess the relation between extent of ischemia and the magnitude of hemodynamic changes, 25 patients (5 with normal coronary arteries and 20 with significant coronary obstructive disease) were studied with rapid atrial pacing and thallium scintigraphy at the time of cardiac catheterization. Hemodynamic variables were measured before, during and after maximal pacing. Thallium was injected intravenously during maximal pacing and scans in three standard views were obtained immediately in the catheterization laboratory, with delayed scans obtained 4 hours after the cessation of pacing. The three thallium scans were each subdivided into five segments, and a thallium score was obtained on the basis of the total number of segments that were hypoperfused. Each patient was assigned a total thallium score corresponding to thallium defects at maximal pacing, as well as a redistributed thallium score corresponding to the difference between thallium score at maximal pacing and that 4 hours later.With pacing, patients with normal coronary arteries demonstrated no significant change in baseline hemodynamic variables, whereas patients with coronary artery disease exhibited a decrease in cardiac index, an increase in systemic vascular resistance, a widening of arteriovenous oxygen difference, an increase in pulmonary capillary wedge pressure and mean pulmonary artery pressure during maximal pacing and an increase in left ventricular end-diastolic pressure immediately after pacing. There was a significant correlation (Spearman rank r = 0.64, p < 0.01) between redistributed thallium score and an increase in left ventricular end-diastolic pressure in the postpacing period. Moreover, there was an even higher correlation (Spearman rank r = 0.90, p < 0.001) between total thallium score and the postpacing increase in end-diastolic pressure.It is concluded that in patients with coronary artery disease the magnitude of pacing-induced hemodynamic changes reflects both the amount of myocardial tissue at ischemic jeopardy and the total mass of hypoperfused myocardium during maximal pacing stress.