Priest M F, Curry G C, Smith L R, Rogers W J, Mantle J A, Rackley C E, Kouchoukos N T, Russell R O
Division of Cardiology, Department of Medicine, University of Alabama in Birmingham, University Station, Birmingham, Alabama 35294, USA.
Circulation. 1978 Sep;58(3 Pt 2):I62-8.
Twenty-six patients with unstable angina pectoris had biplane left ventricular (LV) angiograms and coronary arteriograms (CAGs) initially and at a median of 1 year following randomization to medical (15 patients) or surgical 11 patients) therapy. Left ventricular segmental wall motion was analyzed by a digital computer yielding segmental ejection fraction for 10 zones along the LV perimeter. Baseline and follow-up CAGs were analyzed simultaneously by one observer, and changes in LV segmental coronary perfusion were estimated. Left ventricular angiograms were analyzed separately from CAGs and independently of knowledge of changes in estimated segmental coronary perfusion. Left ventricular segmental wall motion was more frequently improved in surgical patients than in medical patients. Furthermore, in surgical patients there was a significant correlation between changes in LV segmental wall motion and perfusion to LV segments supplied by the left anterior descending coronary artery, whereas no such correlation for any segment was found in the medical group. Thus, this prospective randomized study suggests that, in patients with unstable angina, coronary revascularization may significantly improve LV segmental wall motion compared to medically treated patients. In the surgical group, improvement in LV wall motion relates to improvement in coronary perfusion to the segments supplied by the left anterior descending artery.
26例不稳定型心绞痛患者在随机接受药物治疗（15例）或手术治疗（11例）后，最初及中位数为1年时接受了双平面左心室（LV）血管造影和冠状动脉造影（CAG）。通过数字计算机分析左心室节段性壁运动，得出沿左心室周长10个区域的节段性射血分数。由一名观察者同时分析基线和随访时的CAG，并估计左心室节段性冠状动脉灌注的变化。左心室血管造影与CAG分开分析，且独立于估计的节段性冠状动脉灌注变化的知识。手术患者的左心室节段性壁运动比药物治疗患者更常改善。此外，在手术患者中，左心室节段性壁运动的变化与左前降支冠状动脉供血的左心室节段的灌注之间存在显著相关性，而在药物治疗组中未发现任何节段有这种相关性。因此，这项前瞻性随机研究表明，在不稳定型心绞痛患者中，与药物治疗患者相比，冠状动脉血运重建可能显著改善左心室节段性壁运动。在手术组中，左心室壁运动的改善与左前降支供血节段的冠状动脉灌注改善有关。
