Iliceto S, Caiati C, Tota F, Rizzon P
Institute of Cardiovascular Diseases, University of Bari-Policlinico, Italy.
Drugs. 1992;43 Suppl 1:33-6. doi: 10.2165/00003495-199200431-00008.
Stress-induced wall motion abnormalities are a sensitive marker of myocardial ischaemia. Stress echocardiography has recently been the subject of increasing interest because of its improved feasibility and compatibility with new and effective alternative stresses. Transoesophageal atrial pacing (TAP) with 2-dimensional echocardiography (2-D echo) is a recently developed echo-cardiographic stress procedure that has been shown to be reliable and effective in both the diagnosis and evaluation of stress-induced myocardial ischaemia. TAP with 2-D echo was performed after treatment with placebo and intravenous gallopamil 0.03 mg/kg in 12 patients with stable, reproducible angina of effort. Compared with placebo, gallopamil treatment increased the time to 1 mm ST-segment depression (6.6 vs 5.3 minutes; p less than 0.05) and improved the ventricular wall motion score at a heart rate of 130 beats/min (17 vs 15; p less than 0.01) and 150 beats/min (13 vs 11; p = 0.07). Three patients who developed angina after placebo administration were symptom-free after gallopamil. Thus, gallopamil exerts a beneficial effect on atrial pacing-induced ischaemia, by increasing the pacing time to the ischaemic threshold and reducing the extent of dysfunctional myocardium during ischaemia.
应激诱导的室壁运动异常是心肌缺血的敏感标志物。由于应激超声心动图具有更高的可行性以及与新的有效替代应激方法的兼容性，近年来它越来越受到关注。经食管心房起搏（TAP）联合二维超声心动图（2-D echo）是一种最近开发的超声心动图应激检查方法，已被证明在应激诱导的心肌缺血的诊断和评估中可靠且有效。对12例稳定、可重复性劳力性心绞痛患者在给予安慰剂和静脉注射0.03mg/kg加洛帕米治疗后进行TAP联合2-D echo检查。与安慰剂相比，加洛帕米治疗增加了ST段压低1mm的时间（6.6分钟对5.3分钟；p<0.05），并改善了心率为130次/分钟时的室壁运动评分（17对15；p<0.01）以及心率为150次/分钟时的室壁运动评分（13对11；p = 0.07）。3例在给予安慰剂后出现心绞痛的患者在使用加洛帕米后无症状。因此，加洛帕米通过增加达到缺血阈值的起搏时间并减少缺血期间功能失调心肌的范围，对心房起搏诱导的缺血产生有益作用。
