Electromechanical interrelations during dobutamine stress in normal subjects and patients with coronary artery disease: comparison of changes in activation and inotropic state
Electromechanical interrelations during dobutamine stress in normal subjects and patients with coronary artery disease: comparison of changes in activation and inotropic state
复制标题
DOI：
10.1136/heart.85.4.411
复制
发表时间：
2001-04-01
期刊：
影响因子：
5.7
通讯作者：
Henein, MY
中科院分区：
文献类型：
--
作者：
Duncan, AM;O'Sullivan, CA;Henein, MY
目的：探讨多巴酚丁胺负荷时左室激活改变对正常人和冠心病患者左心功能的影响，并与正性肌力反应进行鉴别。设计前瞻性分析12导联静息和高峰负荷时12导联的心电图和超声心动图。建立具有无创药理负荷试验设施的心脏病三级转诊中心。方法对22例冠心病患者和17例年龄匹配的对照组进行比较。用多普勒超声心动图评价左心室射血功能和充盈状态。激活效果与相对左心室射血和充盈时间以及Z比值([左心室射血+充盈时间]/RR间期)相关。结果：对照组QRS缩短4ms(P<0.001)，总射血和充盈间期延长(分别为2 S/分钟和5 S/分钟，P<0.001)。Z比值增大，与QRS缩短呈正相关(r(2)=0.69)。主动脉峰值加速度增加135%，p<；0.001。在患者中，QRS在峰值应力时延长(延长9ms，p<；0.001)。总射血和充盈时间无明显变化，但Z比值下降，与QRS延长呈正相关(r(2)=0.65)。然而，PAA增加了63%，p<；0.001。结论：相对射血和充盈时间反映的是静息状态和负荷状态下的心室激活，与变力状态的变化无关。相比之下，无论激活程度如何，主动脉峰值加速度反映的是多巴酚丁胺对心肌的正性肌力作用。
Objective-To identify the effects of altered ventricular activation during dobutamine stress on left ventricular function in normal subjects and in patients with coronary artery disease, and to distinguish these from an inotropic response.Design-Prospective analysis of 12 lead ECG and echocardiogram at rest and at peak stress.Setting-Tertiary referral centre for cardiac disease equipped with non-invasive facilities for pharmacological stress testing.Methods-22 patients with coronary artery disease were compared with 17 age matched controls. Left ventricular ejection and filling patterns were assessed using Doppler echocardiography. Activation effects were correlated with relative left ventricular ejection and filling times, and the Z ratio ([left ventricular ejection + filling times]/RR interval). Inotropic response was measured from peak aortic acceleration.Results-In controls, QRS shortened (by 4 ms, p < 0.001), and total ejection and filling periods lengthened (by 2 s/min, p < 0.01 and 5 s/min, p < 0.001, respectively). The Z ratio thus increased and correlated with QRS shortening (r(2) = 0.69). Peak aortic acceleration (PAA) increased by 135%, p < 0.001. In patients, QRS lengthened at peak stress (by 9 ms, p < 0.001). Total ejection and filling times did not change, but Z ratio fell, correlating with QRS prolongation (r(2) = 0.65). Nevertheless, PAA increased by 63%, p < 0.001.Conclusions-Relative ejection and filling times reflect ventricular activation at rest and during stress independent of changes in inotropic state. By contrast, peak aortic acceleration reflects the positive inotropic effect of dobutamine on the myocardium, regardless of changes in activation.