Regional myocardial metabolism of high-energy phosphates during isometric exercise in patients with coronary artery disease.
Regional myocardial metabolism of high-energy phosphates during isometric exercise in patients with coronary artery disease.
复制标题
冠状动脉疾病患者等长运动期间高能磷酸盐的局部心肌代谢。
DOI：
10.1056/nejm199012063232304
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发表时间：
1990
期刊：
影响因子：
--
通讯作者：
Gerstenblith,G
中科院分区：
文献类型：
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作者：
Weiss,RG;Bottomley,PA;Hardy,CJ;Gerstenblith,G
维持细胞内的高能磷酸盐水平是心肌功能和保存所必需的。在动物中，严重心肌缺血的特点是磷酸肌酸的迅速丧失和磷酸肌酸与ATP比值的降低。方法为了确定人类是否可以检测到缺血性代谢变化，我们记录了在等距握力运动之前、期间和之后，来自前心肌的空间定位磷-31核磁共振（31P NMR）谱。结果正常组（n = 11）和非缺血性心脏病组（n = 9）静息时左室壁磷酸肌酸与ATP比值的平均值（±SD）分别为1.72±0.15和1.59±0.31，两组在握力运动时该比值均无变化。然而，在冠心病患者和左前降支或左主干严重狭窄（≥70%）导致的缺血患者（n = 16）中，该比值从休息时的1.45±0.31下降到运动时的0.91±0.24 (P<0.001)，运动后2分钟恢复到1.27±0.38。只有3例冠心病患者出现运动时缺血的临床症状。5例患者血运重建术后重复运动试验，休息时1.60±0.20，运动时1.62±0.18 （P无统计学意义），而血运重建术前休息时1.51±0.19，运动时1.02±0.26 （P<0.02）。结论心肌缺血患者握力运动时磷酸肌酸与ATP比值的降低反映了血流受损时心肌氧供需的短暂不平衡。31p核磁共振运动试验是评估缺血对高能磷酸盐心肌代谢影响和监测治疗反应的有效方法。[J] .中华医学杂志1990；32(3):1593 - 600。
BackgroundThe maintenance of cellular levels of high-energy phosphates is required for myocardial function and preservation. In animals, severe myocardial ischemia is characterized by the rapid loss of phosphocreatine and a decrease in the ratio of phosphocreatine to ATP.MethodsTo determine whether ischemic metabolic changes are detectable in humans, we recorded spatially localized phosphorus-31 nuclear-magnetic-resonance (31P NMR) spectra from the anterior myocardium before, during, and after isometric hand-grip exercise.ResultsThe mean (±SD) ratio of phosphocreatine to ATP in the left ventricular wall when subjects were at rest was 1.72±0.15 in normal subjects (n = 11) and 1.59±0.31 in patients with nonischemic heart disease (n = 9), and the ratio did not change during hand-grip exercise in either group. However, in patients with coronary heart disease and ischemia due to severe stenosis (≥70 percent) of the left anterior descending or left main coronary arteries (n = 16), the ratio decreased from 1.45±0.31 at rest to 0.91±0.24 during exercise (P<0.001) and recovered to 1.27±0.38 two minutes after exercise. Only three patients with coronary heart disease had clinical symptoms of ischemia during exercise. Repeat exercise testing in five patients after revascularization yielded values of 1.60±0.20 at rest and 1.62±0.18 during exercise (P not significant), as compared with 1.51±0.19 at rest and 1.02±0.26 during exercise before revascularization (P<0.02).ConclusionsThe decrease in the ratio of phosphocreatine to ATP during hand-grip exercise in patients with myocardial ischemia reflects a transient imbalance between oxygen supply and demand in myocardium with compromised blood flow. Exercise testing with31P NMR is a useful method of assessing the effect of ischemia on myocardial metabolism of high-energy phosphates and of monitoring the response to treatment. (N Engl J Med 1990; 323:1593–600.)