Herdy A H, Moritz P, Assis A V, Ribeiro F, Collaço J, Ribeiro J P
Instituto de Cardiologia de Santa Catarina, Florianópolis, SC, Brazil.
Braz J Med Biol Res. 2007 Feb;40(2):159-65. doi: 10.1590/s0100-879x2007000200002.
Patients with heart failure who have undergone partial left ventriculotomy improve resting left ventricular systolic function, but have limited functional capacity. We studied systolic and diastolic left ventricular function at rest and during submaximal exercise in patients with previous partial left ventriculotomy and in patients with heart failure who had not been operated, matched for maximal and submaximal exercise capacity. Nine patients with heart failure previously submitted to partial left ventriculotomy were compared with 9 patients with heart failure who had not been operated. All patients performed a cardiopulmonary exercise test with measurement of peak oxygen uptake and anaerobic threshold. Radionuclide left ventriculography was performed to analyze ejection fraction and peak filling rate at rest and during exercise at the intensity corresponding to the anaerobic threshold. Groups presented similar exercise capacity evaluated by peak oxygen uptake and at anaerobic threshold. Maximal heart rate was lower in the partial ventriculotomy group compared to the heart failure group (119 +/- 20 vs 149 +/- 21 bpm; P < 0.05). Ejection fraction at rest was higher in the partial ventriculotomy group as compared to the heart failure group (41 +/- 12 vs 32 +/- 9%; P < 0.0125); however, ejection fraction increased from rest to anaerobic threshold only in the heart failure group (partial ventriculotomy = 44 +/- 17%; P = non-significant vs rest; heart failure = 39 +/- 11%; P < 0.0125 vs rest; P < 0.0125 vs change in the partial ventriculotomy group). Peak filling rate was similar at rest and increased similarly in both groups at the anaerobic threshold intensity (partial ventriculotomy = 2.28 +/- 0.55 EDV/s; heart failure = 2.52 +/- 1.07 EDV/s; P < 0.0125; P > 0.05 vs change in partial ventriculotomy group). The abnormal responses demonstrated here may contribute to the limited exercise capacity of patients with partial left ventriculotomy despite the improvement in resting left ventricular systolic function.
接受部分左心室切开术的心力衰竭患者静息时左心室收缩功能有所改善，但功能能力有限。我们研究了既往接受过部分左心室切开术的患者以及未接受手术的心力衰竭患者在静息和次极量运动时的左心室收缩和舒张功能，这些患者的最大和次极量运动能力相匹配。将9例既往接受过部分左心室切开术的心力衰竭患者与9例未接受手术的心力衰竭患者进行比较。所有患者均进行了心肺运动试验，测量了峰值摄氧量和无氧阈值。进行放射性核素左心室造影以分析静息和对应无氧阈值强度运动时的射血分数和峰值充盈率。两组通过峰值摄氧量和无氧阈值评估的运动能力相似。部分心室切开术组的最大心率低于心力衰竭组（119±20 vs 149±21次/分；P<0.05）。部分心室切开术组静息时的射血分数高于心力衰竭组（41±12 vs 32±9%；P<0.0125）；然而，仅心力衰竭组的射血分数从静息时到无氧阈值时增加（部分心室切开术组=44±17%；与静息时相比P无统计学意义；心力衰竭组=39±11%；与静息时相比P<0.0125；与部分心室切开术组的变化相比P<0.0125）。静息时峰值充盈率相似，两组在无氧阈值强度时均有类似增加（部分心室切开术组=2.28±0.55 EDV/s；心力衰竭组=2.52±1.07 EDV/s；P<0.0125；与部分心室切开术组的变化相比P>0.05）。尽管静息时左心室收缩功能有所改善，但此处显示的异常反应可能导致部分左心室切开术患者运动能力受限。
