运动诱发的室内梯度作为心脏综合征X患者心肌缺血的常见潜在原因。

Exercise-induced intra-ventricular gradients as a frequent potential cause of myocardial ischemia in cardiac syndrome X patients.

作者信息

Cotrim Carlos, Almeida Ana G, Carrageta Manuel

机构信息

Cardiology Department, Garcia de Orta Hospital, Almada, Portugal.

出版信息

Cardiovasc Ultrasound. 2008 Jan 14;6:3. doi: 10.1186/1476-7120-6-3.

DOI:10.1186/1476-7120-6-3

PMID:18194574

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC2253520/

Abstract

BACKGROUND

The development of intra-ventricular gradients (IVG) during dobutamine or exercise stress is not infrequent, and can be associated to symptoms during stress. The purpose of this study was to assess the occurrence of IVG during exercise stress echocardiography in cardiac syndrome X patients.

METHODS

We prospectively evaluated 91 patients (pts) mean aged 51 +/- 12 years (age ranged 20 to 75 years old), 44 of whom were women. All pts had angina, positive exercise ECG treadmill testing, normal rest echocardiogram and no coronary artery disease on coronary angiogram (cardiac X syndrome). After complete Doppler echocardiographic evaluation with determination of left ventricular outflow tract index (LVOTi), relative left ventricular wall thickness (RLVWT) and left ventricular end-diastolic volume index (LVDVi), all patients underwent stress echocardiography with two-dimensional and Doppler echographic evaluation during and after treadmill exercise.

RESULTS

For analysis purpose patients were divided in 2 groups, according to the development of IVG. Doppler evidence of IVG was found in 33 (36%) of the patients (Group A), with mean age 47 +/- 14 years old (age ranged 20 to 72 years) and with a mean end-systolic peak gradient of 86 +/- 34 mmHg (ranging from 30 to 165 mmHg). The IVG development was accompanied by SAM of the mitral valve in 23 pts. Three of these pts experienced symptomatic hypotension. Ten were women (30% pts). 58 pts in group B, 34 of whom were women (59%) (p = 0,01 vs group A), mean aged 53,5 +/- 10,9 years old (age ranged 34 to 75 years) (p = 0,03 vs group A), did not develop IVG. LVOTi was 10,29 +/- 0,9 mm/m2 in group A and 11,4 +/- 1 mm/m2 in group B (p < 0,000); RLVWT was 0,36 +/- 0,068 in group A and 0,33 +/- 0,046 in group B (p < 0,01); LVDVi was 44,8 +/- 10 ml/m2 in group A and 56 +/- 11,6 ml/m2 in group B (p = 0,000).

CONCLUSION

A significant number of patients with cardiac X syndrome developed IVG during upright exercise in treadmill. These pts (group A) are mainly males and younger than those who did not develop IVG.2. The development of IVG and mitral valve SAM on exertion seems to be associated with ST segment downsloping during stress testing in patients without epicardial coronary disease.3. The development of IVG and mitral valve SAM seems to be associated with lower LVOTi, lower LVDVi and higher RLVWT.

摘要

背景

在多巴酚丁胺或运动负荷试验期间，心室内压力阶差（IVG）的出现并不罕见，且可能与负荷试验期间的症状有关。本研究的目的是评估心脏综合征X患者在运动负荷超声心动图检查期间IVG的发生情况。

方法

我们前瞻性评估了91例患者，平均年龄51±12岁（年龄范围20至75岁），其中44例为女性。所有患者均有胸痛症状、运动平板心电图试验阳性、静息超声心动图正常且冠状动脉造影无冠状动脉疾病（心脏X综合征）。在通过测定左心室流出道指数（LVOTi）、相对左心室壁厚度（RLVWT）和左心室舒张末期容积指数（LVDVi）完成完整的多普勒超声心动图评估后，所有患者均接受了运动负荷超声心动图检查，在平板运动期间及运动后进行二维和多普勒超声心动图评估。

结果

为便于分析，根据IVG的发生情况将患者分为2组。33例（36%）患者（A组）发现有IVG的多普勒证据，平均年龄47±14岁（年龄范围20至72岁），平均收缩末期峰值压力阶差为86±34 mmHg（范围30至165 mmHg）。23例患者的IVG发生伴有二尖瓣收缩期前向运动（SAM）。其中3例患者出现症状性低血压。10例为女性（占患者的30%）。B组58例患者，其中34例为女性（占59%）（与A组相比p = 0.01），平均年龄53.5±10.9岁（年龄范围34至75岁）（与A组相比p = 0.03），未发生IVG。A组LVOTi为10.29±0.9 mm/m²，B组为11.4±1 mm/m²（p < 0.000）；A组RLVWT为0.36±0.068，B组为0.33±0.046（p < 0.01）；A组LVDVi为44.8±10 ml/m²，B组为56±11.6 ml/m²（p = 0.000）。

结论

相当数量的心脏X综合征患者在平板直立运动期间出现IVG。这些患者（A组）主要为男性，且比未出现IVG的患者年轻。2. 在无冠状动脉疾病的患者中，运动时IVG和二尖瓣SAM的发生似乎与负荷试验期间ST段压低有关。3. IVG和二尖瓣SAM的发生似乎与较低的LVOTi、较低的LVDVi和较高的RLVWT有关。