O'Sullivan Christine A, Duncan Alison, Daly Caroline, Li Wei, Oldershaw Paul, Henein Michael Y
The Cardiac Department, Royal Brompton Hospital and National Heart and Lung Institute, Imperial College, London, United Kingdom.
Am J Cardiol. 2005 Sep 1;96(5):622-7. doi: 10.1016/j.amjcard.2005.04.031.
We investigated markers of ischemic dysfunction and their relation to overall right ventricular (RV) performance during dobutamine stress echocardiography in patients who had coronary artery disease. Thirty-three patients (58 +/- 10 years old) who had 3-vessel coronary artery disease were compared with 17 age-matched controls (58 +/- 11 years old). RV long-axis amplitude (M mode), systolic and diastolic myocardial tissue Doppler velocities, and filling and ejection velocities were measured, and cardiac output (CO) was calculated at rest and during peak stress. There was no difference in RV size (inlet dimension <3.5 cm), RV systolic long-axis amplitude, systolic and diastolic velocities, peak early/late diastolic velocity ratio, and RV CO between patients and controls at rest. During stress, RV systolic long-axis amplitude increased in controls (from 24 +/- 6 to 30 +/- 5 mm) and CO increased significantly (from 4.9 +/- 1.2 to 12.5 +/- 2.1 L/min, p <0.001 for the 2 items). In contrast, RV amplitude did not change with stress in patients (from 24 +/- 5 to 22 +/- 6 mm, p = NS), and the stress-increment in CO was augmented (from 4.2 +/- 1.2 to 8.3 +/- 2.0 L/min, p <0.001 vs control stress increment). Failure to increase RV systolic amplitude >2 mm was 79% sensitive and 88% specific for detecting ischemic RV dysfunction, and there was a close correlation between stress-induced change in RV systolic amplitude and change in CO in patients (r = 0.56, p <0.001). Early diastolic velocity increased in controls (from 10.8 +/- 3.2 to 13.1 +/- 3.6 cm/s, p <0.01) but did not change in patients (from 11.5 +/- 3.7 to 11.3 +/- 4.8 cm/s, p = NS). RV shortening after ejection did not appear in any control subject but did develop in 8 of 33 patients, thus contributing to the decrease in RV peak early/late diastolic velocity ratio in patients (from 1.1 +/- 0.3 to 0.76 +/- 0.4, p <0.001) compared with that in controls (1.3 +/- 0.3 to 1.0 +/- 0.2, p <0.001). In conclusion, markers of RV dysfunction are not related to left ventricular wall motion score index or long-axis changes with stress.
我们研究了冠状动脉疾病患者在多巴酚丁胺负荷超声心动图检查期间缺血性功能的标志物及其与右心室（RV）整体功能的关系。将33例（年龄58±10岁）患有三支血管冠状动脉疾病的患者与17例年龄匹配的对照组（年龄58±11岁）进行比较。测量RV长轴振幅（M型）、收缩期和舒张期心肌组织多普勒速度以及充盈和射血速度，并计算静息和峰值负荷时的心输出量（CO）。患者和对照组在静息时的RV大小（入口尺寸<3.5 cm）、RV收缩期长轴振幅、收缩期和舒张期速度、舒张早期/晚期峰值速度比值以及RV CO没有差异。负荷期间，对照组的RV收缩期长轴振幅增加（从24±6增加到30±5 mm），CO显著增加（从4.9±1.2增加到12.5±2.1 L/min，这两项p<0.001）。相比之下，患者的RV振幅在负荷时没有变化（从24±5到22±6 mm，p=无统计学意义），而CO的负荷增加幅度更大（从4.2±1.2增加到8.3±2.0 L/min，与对照组负荷增加相比p<0.001）。RV收缩期振幅增加未超过2 mm对检测缺血性RV功能障碍的敏感性为79%，特异性为88%，并且患者中应激诱导的RV收缩期振幅变化与CO变化之间存在密切相关性（r=0.56，p<0.001）。对照组舒张早期速度增加（从10.8±3.2增加到13.1±3.6 cm/s，p<0.01），而患者未发生变化（从11.5±3.7到11.3±4.8 cm/s，p=无统计学意义）。射血后RV缩短在任何对照组受试者中均未出现，但在33例患者中的8例中出现，因此与对照组相比（从1.3±0.3到1.0±0.2，p<0.001），患者的RV舒张早期/晚期峰值速度比值降低（从1.1±0.3到0.76±0.4，p<0.001）。总之，RV功能障碍的标志物与左心室壁运动评分指数或负荷时左心室长轴变化无关。
