Impairment of myocardial perfusion and function during painless myocardial ischemia.
Impairment of myocardial perfusion and function during painless myocardial ischemia.
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无痛心肌缺血期间心肌灌注和功能受损。
DOI：
10.1016/s0735-1097(83)80211-3
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发表时间：
1983
影响因子：
24
通讯作者：
A. Maseri
中科院分区：
文献类型：
--
作者：
S. Chierchia;Mauro Lazzari;Ben Freedman;Claudio Brunelli;A. Maseri
在连续心电图监测期间，对14例因静息心绞痛而入住冠心病监护室的患者进行了平均13.6小时的左心室（或肺动脉和全身动脉）血流动力学测量。在293例一过性ST段和T波改变中，247例（84%）完全无症状。63%的无症状发作与左心室舒张末期或肺动脉舒张压升高5 mm Hg或更高相关; 15%的患者血压升高较小（2 - 4 mm Hg），22%的患者血压无变化或升高小于2 mm Hg。收缩和舒张峰值dP/dt（左心室压力的一阶导数）分别在84%和81%的无症状发作中降至100 mm Hg/s或以上。在3例患者中测量的大心静脉血氧饱和度显示心肌氧摄取增加，与疼痛发作相似，其发生在无症状心电图变化之前并伴随无症状心电图变化。这些结果表明，无症状的心电图改变代表短暂的心肌缺血。无症状和有症状发作的比较显示，无症状发作一般较短（253 ± 159与674 ± 396秒，概率[p]<0.001），左心室功能受损较少：左心室舒张末期压或肺动脉舒张压升高较小，（5.9 ± 5.0 vs 16.5 ± 6.9 mm Hg，p <0.001），左室收缩峰值dP/dt降低较小（252 ± 156与395 ± 199 mm Hg/s，p <0.001）和舒张dP/dt（259 ± 191与413 ± 209 mm Hg/s，p <0.001）。然而，在个体患者中，观察到持续时间和严重程度相似的无症状和症状发作。缺血的持续时间和严重程度对于心绞痛的发生似乎很重要，但还必须涉及其他因素。
Left ventricular (or pulmonary and systemic arterial) hemodynamics were measured for a mean of 13.6 hours during continuous electrocardiographic monitoring in 14 patients admitted to the coronary care unit because of angina at rest. Of 293 episodes of transient ST segment and T wave changes identified, 247 (84%) were completely asymptomatic. Sixty-three percent of asymptomatic episodes were associated with an elevation of the left ventricular end-diastolic or pulmonary artery diastolic pressure of 5 mm Hg or more; in 15% there were smaller elevations (2 to 4 mm Hg) and in 22% there were no changes or less than a 2 mm Hg elevation of pressure. The peak contraction and relaxation dP/dt (first deriviative of left ventricular pressure) were reduced to 100 mm Hg/s or more in 84 and 81 % of asymptomatic episodes, respectively. Great cardiac vein oxygen saturation measured in three patients showed an increased myocardial oxygen extraction similar to that seen in painful episodes, which preceded and accompanied asymptomatic electrocardiographic changes. These results indicate that asymptomatic electrocardiographic changes represent transient myocardial ischemia.Comparison of asymptomatic and symptomatic episodes revealed that asymptomatic episodes were generally shorter (253 ± 159 versus 674 ± 396 seconds, probability [p] < 0.001) and produced less impairment of left ventricular function: there were smaller elevations of left ventricular end-diastolic or pulmonary artery diastolic pressure (5.9 ± 5.0 versus 16.5 ± 6.9 mm Hg, p < 0.001), and smaller reductions of peak left ventricular contraction dP/dt (252 ± 156 versus 395 ± 199 mm Hg/s, p < 0.001) and relaxation dP/dt (259 ± 191 versus 413 ± 209 mm Hg/s, p < 0.001). In individual patients, however, asymptomatic and symptomatic episodes of similar duration and severity were observed. The duration and severity of ischemia appear important for the genesis of anginal pain, but additional factors must be involved.