Influence of coronary occlusion during PTCA on end-systolic and end-diastolic pressure-volume relations in humans.
Influence of coronary occlusion during PTCA on end-systolic and end-diastolic pressure-volume relations in humans.
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PTCA 期间冠状动脉闭塞对人体收缩末期和舒张末期压力-容积关系的影响。
DOI：
10.1161/01.cir.81.2.447
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发表时间：
1990
期刊：
影响因子：
37.8
通讯作者：
Maughan,WL
中科院分区：
文献类型：
--
作者：
Kass,DA;Midei,M;Brinker,J;Maughan,WL
本文对10例经皮腔内冠状动脉成形术（PTCA）患者急性冠状动脉闭塞对左室收缩和舒张压-容积关系的影响进行了研究。通过导管和微压计技术获得压力-体积关系，并与短暂下腔静脉阻塞改变的体积负荷有关。在基线、缺血60-90秒以及血管成形术球囊收缩后返回基线时，获得收缩期末期和舒张末期的压力-容量关系。冠状动脉闭塞明显改变收缩和舒张心室功能。收缩功能障碍的特征是收缩末期压力-容积关系可重复右移（+25.4 +/- 18.4 ml），左前降支和旋冠状动脉闭塞近端（+41 ml）大于远端或右冠状动脉闭塞（+15.4 ml, p < 0.05）。闭塞也降低了心室收缩功能指标，如收缩期末期压力-容积关系斜率（从4.2降至2.8 mm Hg/ml）和预负荷可负荷脑卒中功（从97降至78.6 mm Hg）。血管成形术成功解决了所有的收缩（和舒张）变化。血管成形术期间舒张异常的特征是压力松弛时间延长，静息舒张压力-容积数据向上移动，心室弹性刚度明显增加。然而，当比较下腔静脉闭塞期间多次心跳的舒张末期数据时，对照组和缺血性舒张末期压力-容量关系显示很少或没有差异。因此，人类冠状动脉闭塞时静息舒张压-容积关系的升高和腔室弹性刚度的明显增加似乎主要是由右心室或心包负荷的改变引起的。这些数据表明，压力-容量分析在评估冠状动脉病变和再灌注的功能意义方面是有用的。
The influence of acute coronary occlusion on systolic and diastolic left ventricular pressure-volume relations was studied in 10 patients undergoing percutaneous transluminal coronary angioplasty (PTCA). Pressure-volume relations were obtained by conductance catheter and micromanometer techniques and with volume load altered by transient inferior vena caval occlusion. End-systolic and end-diastolic pressure-volume relations were obtained at baseline, during 60-90 seconds of ischemia, and at return to baseline after angioplasty balloon deflation. Coronary occlusion significantly altered systolic and diastolic chamber function. Systolic dysfunction was characterized by a reproducible rightward shift of the end-systolic pressure-volume relation (+25.4 +/- 18.4 ml) that was greater for proximal left anterior descending and circumflex coronary artery occlusions (+41 ml) than for distal or right coronary artery occlusions (+15.4 ml, p less than 0.05). Occlusion also lowered chamber systolic function indexes, such as the end-systolic pressure-volume relation slope (from 4.2 to 2.8 mm Hg/ml) and preload recruitable stroke work (from 97 to 78.6 mm Hg). All systolic (and diastolic) changes were resolved with successful angioplasty. Diastolic abnormalities during angioplasty were characterized by prolonged pressure relaxation and an upward shift of the resting diastolic pressure-volume data and by an apparent increase in chamber elastic stiffness. However, when end-diastolic data from multiple beats during inferior vena caval occlusion were compared, control and ischemic end-diastolic pressure-volume relations displayed little or no difference. Thus, elevations in resting diastolic pressure-volume relations and apparent increase in chamber elastic stiffness during coronary occlusion in humans appear dominated by altered right ventricular or pericardial loading. These data indicate that pressure-volume analysis is useful in assessing the functional significance of coronary lesions and reperfusion.