Editorial: Evaluation of Inotropic Contractile Reserve in Ischemic Heart Disease Using Postextrasystolic Potentiation
Editorial: Evaluation of Inotropic Contractile Reserve in Ischemic Heart Disease Using Postextrasystolic Potentiation
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社论：利用期外收缩后增强评估缺血性心脏病中的正性收缩储备
作者：
P. Cohn
虽然收缩末期的空间不同步在冠状动脉疾病患者中有很好的特征，但区域不同步的评估受到技术限制的阻碍。我们开发了一种计算机辅助方法，从平衡(心电门控)放射性核素脑室图分析区域不同步。20例左心室造影正常的患者(9例冠状动脉造影正常，11例冠状动脉疾病患者，2组)和20例造影期间无晕厥的患者(3组)。区域不同步的最早证据出现在收缩早期。1/3收缩时局部射血分数第1组为0.32±0.02(平均值+扫描电子显微镜)，第2组为0.22±0.01(p<；0.001)，第3组为0.12±0.01(p<；0.001)。在第三组中，收缩早期和舒张期均出现严重的局部不同步现象：5例(25%)患者出现早期收缩相矛盾，13例(65%)局部射血分数延长，16例(80%)收缩末期峰值射血分数降低。因此，在冠状动脉疾病严重程度不断增加的患者中，似乎存在逐渐增加的区域不同步。
SUMMARY While spatial asynergy at end-systole has been well characterized in patients with coronary artery disease, assessment of regional asynchrony has been hampered by technical constraints. We developed a computer-assisted method for analyzing regional asynchrony from the equilibrium (ECG-gated) radionuclide ventriculogram. Twenty patients with normal contrast left ventriculograms (nine with a normal coronary arteriogram [group 1] and 11 with coronary artery disease [group 2] ) and 20 patients with asynergy during contrast ventriculography (group 3) were studied. The earliest evidence of regional asynchrony occurred in early systole. Regional ejection fraction at one-third systole was 0.32 i 0.02 (mean + SEM) in group 1, 0.22 4 0.01 in group 2 (p < 0.001) and 0.12 ± 0.01 in asynergic regions in group 3 patients (p < 0.001). In group 3, severe forms of regional asynchrony appeared in both early systole and early diastole: five patients (25%) had early systolic paradox, 13 (65%) had regional prolongation of peak ejection fraction and 16 (80%) had reduced percent peak ejection fraction at global end-systole. It appears, therefore, that there is progressively increasing regional asynchrony in patients with increasing severity of coronary artery disease.