Spinelli Letizia, Petretta Mario, Verderame Giuseppe, Carbone Giuseppe, Venetucci Angela Assunta, Petretta Andrea, Acampa Wanda, Bonaduce Domenico, Colao Annamaria, Cuocolo Alberto
Department of Internal Medicine, Federico II University, 80131 Naples, Italy.
J Clin Endocrinol Metab. 2003 Sep;88(9):4105-9. doi: 10.1210/jc.2003-030462.
Exercise-induced impairment of left ventricular (LV) ejection fraction is common in patients with acromegaly and normal resting systolic function. This study aimed to clarify whether diastolic dysfunction plays a role in the abnormal adaptation to exercise in these patients. Forty-eight patients with active acromegaly underwent LV radionuclide angiography at rest and during exercise. Doppler echocardiography was also performed to assess LV mass index and diastolic function by combined analysis of mitral and pulmonary flow velocity curves. LV ejection fraction at peak exercise was related to rest ejection fraction (r = 0.78; P < 0.001), peak filling rate (r = 0.55; P < 0.01), LV mass index (r = -0.56; P < 0.001), and the difference between duration of diastolic reverse pulmonary vein flow and mitral flow at atrial contraction (Delta duration) (r = -0.54; P < 0.01). At stepwise regression analysis, rest ejection fraction and Delta duration were the only variables that independently influenced (P < 0.001) ejection fraction at peak exercise. Diastolic dysfunction is important in determining cardiac performance during exercise in patients with acromegaly and normal resting systolic function. Combined analysis of pulmonary vein and mitral flow velocity curves allows the identification of impaired LV diastolic function in such patients.
运动诱发的左心室射血分数受损在肢端肥大症且静息收缩功能正常的患者中很常见。本研究旨在阐明舒张功能障碍在这些患者运动异常适应过程中是否起作用。48例活动期肢端肥大症患者在静息和运动时接受了左心室放射性核素血管造影检查。还进行了多普勒超声心动图检查，通过对二尖瓣和肺静脉血流速度曲线的联合分析来评估左心室质量指数和舒张功能。运动峰值时的左心室射血分数与静息射血分数（r = 0.78；P < 0.001）、峰值充盈率（r = 0.55；P < 0.01）、左心室质量指数（r = -0.56；P < 0.001）以及心房收缩时舒张期肺静脉反向血流与二尖瓣血流持续时间之差（Δ持续时间）（r = -0.54；P < 0.01）相关。在逐步回归分析中，静息射血分数和Δ持续时间是仅有的独立影响（P < 0.001）运动峰值时射血分数的变量。舒张功能障碍在确定静息收缩功能正常的肢端肥大症患者运动时的心脏功能方面很重要。肺静脉和二尖瓣血流速度曲线的联合分析能够识别此类患者左心室舒张功能受损情况。
