ISCHEMIA IN AORTIC-STENOSIS - HEMODYNAMIC PREDICTION
ISCHEMIA IN AORTIC-STENOSIS - HEMODYNAMIC PREDICTION
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DOI：
10.1016/0002-9149(75)90112-5
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发表时间：
1975-01-01
影响因子：
2.8
通讯作者：
GORLIN, R
中科院分区：
文献类型：
--
作者：
BUCKBERG, G;EBER, L;GORLIN, R
Fallen等人1在1967年研究了12例主动脉瓣狭窄患者在输注异丙肾上腺素前后的记录，以评估血流动力学指标在预测心肌缺血中的价值-定义为低于5%的经心肌乳酸提取或乳酸产生。根据舒张压-时间指数（DPTI）（根据主动脉和左心室压力计算）和需氧量（根据张力-时间指数（TTI）估计）估计潜在的内膜下血液供应。DPTI TTI比率用于估计供给/需求关系。在8例主动脉瓣狭窄但无相关冠状动脉疾病的患者中，4例（A组）在给予异丙肾上腺素后乳酸代谢正常，4例（B组）有缺血的生化证据。4例主动脉瓣狭窄伴冠心病患者中有3例（C组）在给予异丙肾上腺素后糖酵解异常。所有组中计算的主动脉瓣面积相当。单纯主动脉瓣狭窄组，DPTI/TTI <0.30时乳酸代谢异常（P< 0.01）（B组）。当DPTI/TTI大于0.6时，3例主动脉瓣狭窄和相关冠状动脉疾病患者（C组）中有2例显示乳酸代谢异常;第3例患者的这一比值低于0.3。这些结果表明，从这些容易获得的指标计算的供给/需求关系可能有助于（1）预测哪些患者会发生主动脉瓣狭窄缺血，（2）区分相关冠状动脉疾病所起的作用，以及（3）作为计算瓣膜面积的辅助工具，因为不需要定量相关主动脉瓣返流。
The records of 12 patients with aortic stenosis previously studied by Fallen et al. 1 in 1967 before and after infusion of isoproterenol were reviewed to assess the value of hemodynamic indexes in predicting myocardial ischemia—defined as less than 5 percent transmyocardial lactate extraction or lactate production. Potential subendocardial blood supply was estimated from a diastolic pressure-time index (DPTI), calculated from aortic and left ventricular pressure, and oxygen demand, estimated from the tension-time index (TTI). The ratio DPTI TTI was used to estimate the supply/demand relation. Of eight patients with aortic stenosis but without associated coronary artery disease, four (Group A) metabolized lactate normally after administration of isoproterenol, and four (Group B) had biochemical evidence of ischemia. Three of four patients (Group C) with aortic stenosis and associated coronary artery disease had abnormal glycolysis after administration of isoproterenol. Calculated aortic valve areas were comparable in all groups. In patients with aortic stenosis alone, abnormal lactate metabolism occurred whenever DPTI/TTI was less than 0.30 (P< 0.01)(Group B). Two of three patients with aortic stenosis and associated coronary artery disease (Group C) showed abnormal lactate metabolism when DPTI/TTI was greater than 0.6; this ratio was below 0.3 in the third patient. These results suggest that the supply/demand relation calculated from these readily obtained indexes may be useful (1) in predicting in which patients with aortic stenosis ischemia will develop,(2) in distinguishing the role played by associated coronary artery disease, and (3) as an adjunct to calculation of valve area since the quantitation of associated aortic regurgitation is not necessary.