Asynchronous left ventricular regional function and impaired global diastolic filling in patients with coronary artery disease: reversal after coronary angioplasty.
Asynchronous left ventricular regional function and impaired global diastolic filling in patients with coronary artery disease: reversal after coronary angioplasty.
复制标题
冠状动脉疾病患者的异步左心室区域功能和整体舒张期充盈受损：冠状动脉血管成形术后的逆转。
作者：
R. Bonow;D. Vitale;S. Bacharach;T. M. Frederick;K. Kent;Michael V. Green
许多左室收缩功能正常的冠心病患者左室舒张期充盈受损，许多患者在冠状动脉成形术（PTCA）后得到改善。为了探讨这种改善的机制，我们通过放射性核素血管造影研究了26例单支冠状动脉疾病患者成功PTCA前后的局部冠状动脉狭窄。经皮冠状动脉成形术前，所有患者静息时射血分数正常，放射性核素和造影剂血管造影确定的左室局部室壁运动定性正常。通过将左心室感兴趣区域分为20个扇区来定量评估左心室局部功能。对各节段的时间-活动曲线进行相位分析，以平均节段间相位差作为左室局部同步性的指标。在PTCA前，平均扇区间相位差与正常相比增加（6.0 +/- 2.2 vs 4.0 +/- 1.7度，p <0.005），表明非同步区域功能。经皮腔内冠状动脉成形术后，静息时射血分数不变，但静息时左室充盈率峰值从2.5 ± 0.6舒张末期容积/秒增加到3.0 ± 0.6舒张末期容积/秒（p <0.001），并且与平均扇区间相位差从6.0 ± 2.2度减少到5.1 ± 2.3度相关（p <0.05）。在21例经皮冠状动脉腔内成形术（PTCA）后峰值充盈率增加的患者中，有16例患者的平均扇区间相位差降低（p <0.005），而在5例峰值充盈率不变或降低的患者中，有1例患者的平均扇区间相位差降低。因此，经皮冠状动脉腔内成形术后左心室整体充盈的改善与左心室局部行为的同步性有关。为了确定PTCA前局部心肌梗塞的原因，我们从四个左心室象限中的每一个产生了时间-活动曲线。这些数据表明，心脏舒张功能不全是由舒张期而不是收缩期事件的局部变化引起的，而PTCA导致局部舒张功能不全的减少。这些数据表明，在许多冠状动脉疾病和左心室收缩功能正常的患者中，左心室局部舒张功能不同步可能导致整体舒张充盈受损，这是心肌缺血或冠状动脉血流减少的可逆表现。
Left ventricular diastolic filling is impaired in many patients with coronary artery disease and normal left ventricular systolic function, and is improved in many patients after coronary angioplasty (PTCA). To investigate the mechanisms for this improvement, we studied regional asynchrony by radionuclide angiography in 26 patients with single-vessel coronary artery disease before and after successful PTCA. Before PTCA, all patients had normal ejection fractions at rest and normal qualitative left ventricular regional wall motion, as determined by radionuclide and contrast angiography. Quantitative left ventricular regional function was assessed by dividing the left ventricular region of interest into 20 sectors. Phase analysis was performed on each sector's time-activity curve, and the average intersector phase difference was used as an index of left ventricular regional synchrony. Before PTCA, average intersector phase difference was increased compared with normal (6.0 +/- 2.2 vs 4.0 +/- 1.7 degrees, p less than .005), indicating asynchronous regional function. After PTCA, ejection fraction at rest was unchanged, but peak left ventricular filling rate at rest increased from 2.5 +/- 0.6 to 3.0 +/- 0.6 end-diastolic volume/sec (p less than .001) and was associated with a decrease in average intersector phase difference from 6.0 +/- 2.2 to 5.1 +/- 2.3 degrees (p less than .05). Average intersector phase difference decreased in 16 of 21 patients in whom peak filling rate increased after PTCA (p less than .005), compared with one of five patients in whom peak filling rate was unchanged or decreased. Hence, improved global left ventricular filling after PTCA was associated with more synchronous left ventricular regional behavior. To identify the cause of regional asynchrony before PTCA, we then generated time-activity curves from each of four left ventricular quadrants. These data indicated that the asynchrony was caused by regional variation in timing of diastolic rather than systolic events and that PTCA resulted in reduction in regional diastolic asynchrony. These data suggest that in many patients with coronary artery disease and normal left ventricular systolic function, impaired global diastolic filling may result from asynchronous left ventricular regional diastolic function, which is a reversible manifestation of myocardial ischemia or reduced coronary flow.
心脏舒张功能分析：在冠状动脉疾病中的应用。
DOI：
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发表时间：
1983
期刊：
Journal of nuclear medicine : official publication, Society of Nuclear Medicine
影响因子：
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作者：
Miller,TR;Goldman,KJ;Sampathkumaran,KS;Biello,DR;Ludbrook,PA;Sobel,BE
通讯作者：
Sobel,BE