Parodi O, Neglia D, Marcassa C, Marzullo P, Sambuceti G
CNR Institute of Clinical Physiology, Pisa, Italy.
Circulation. 1991 May;83(5 Suppl):III54-61.
Among the clinical manifestations of ischemic heart disease, right coronary artery (RCA) disease offers a wide variety of right and left ventricular ischemic involvement, including prevalent right ventricular dysfunction and severe cardiac failure. Whether the right ventricular impairment is dependent primarily on ischemia of the right ventricle or requires a concomitant left ventricular dysfunction remains debatable. To assess the pathophysiology and clinical relevance of RCA-related ischemia, a systematic study of patients with single RCA disease (either vasospastic angina at rest or typical stable angina) was undertaken by radionuclide ventriculography. A high incidence of ischemia-induced right ventricular dysfunction was observed (93% and 95% in angina at rest and on effort, respectively), either alone or associated with left ventricular impairment. These results were compared with those obtained in a control population with isolated left anterior descending artery disease and either primary or secondary angina pectoris. We infer that the impairment of the right ventricle was related primarily to right ventricular ischemia and that left ventricular dysfunction alone did not cause an important depression of right ventricular systolic function. In conclusion, the clinical manifestations of RCA disease can be protean; the right ventricle can be the target of ischemia, and recognition of its impairment poses diagnostic problems. Radionuclide ventriculography and two-dimensional echocardiography, together with stressors of coronary flow reserve, are reliable techniques for assessing RCA-related ischemia.
在缺血性心脏病的临床表现中，右冠状动脉（RCA）疾病可导致广泛的左右心室缺血累及，包括常见的右心室功能障碍和严重心力衰竭。右心室损害主要是取决于右心室缺血还是需要合并左心室功能障碍仍存在争议。为了评估RCA相关缺血的病理生理学和临床相关性，通过放射性核素心室造影对单支RCA疾病患者（静息性血管痉挛性心绞痛或典型稳定型心绞痛）进行了系统研究。观察到缺血性右心室功能障碍的发生率很高（静息性心绞痛和劳力性心绞痛患者中分别为93%和95%），可单独出现或合并左心室损害。将这些结果与在患有单纯左前降支动脉疾病及原发性或继发性心绞痛的对照人群中获得的结果进行比较。我们推断右心室损害主要与右心室缺血有关，单独的左心室功能障碍并不会导致右心室收缩功能的显著降低。总之，RCA疾病的临床表现可能多种多样；右心室可能是缺血的靶器官，认识到其损害会带来诊断问题。放射性核素心室造影和二维超声心动图，以及冠状动脉血流储备应激试验，是评估RCA相关缺血的可靠技术。
