Bell M R, Nishimura R A, Holmes D R, Bailey K R, Schwartz R S, Vlietstra R E
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905.
J Am Coll Cardiol. 1990 Oct;16(4):959-66. doi: 10.1016/s0735-1097(10)80349-3.
Distal intracoronary infusion of the perfluorochemical Fluosol-DA 20% has been shown to prevent systolic dysfunction during coronary artery balloon occlusion in coronary angioplasty. To assess its effect on global diastolic dysfunction, a randomized, single-blind, crossover protocol comparing intracoronary infusion of Fluosol or no infusion (control) was performed during 60 s balloon inflations in 10 patients (mean age 67 years) undergoing coronary angioplasty. Assessment of global systolic and diastolic function was obtained with high fidelity micromanometer measurements of left ventricular pressure. Eighteen pairs of balloon inflations (Fluosol versus control) were analyzed. Patients reported significantly less severe chest pain during inflations accompanied by Fluosol compared with control. However, during coronary balloon occlusion, no significant differences in the changes from baseline values were observed between Fluosol and control with regard to ventricular relaxation, including the time constant of early ventricular relaxation (tau) and maximal rate of fall in left ventricular pressure (maximal negative dP/dt). No differences between Fluosol and control were observed in terms of the increase in end-diastolic pressure or minimal diastolic pressure during balloon inflation. Mean systolic pressure decrease from baseline values was greater during control than during Fluosol inflations (-9.0 +/- 3.3 mm Hg, p = 0.013), but no significant difference was observed in the change in maximal rate of rise in left ventricular pressure (maximal positive dP/dt). These results suggest that Fluosol does not preserve global left ventricular diastolic function during coronary balloon occlusion, possibly because of its limited oxygen delivery capability relative to arterial blood.
在冠状动脉血管成形术中，向冠状动脉远端注入20%的全氟化合物氟碳乳剂（Fluosol-DA）已被证明可预防冠状动脉球囊闭塞期间的收缩功能障碍。为评估其对整体舒张功能障碍的影响，在10例（平均年龄67岁）接受冠状动脉血管成形术的患者进行60秒球囊充气期间，采用随机、单盲、交叉方案，比较冠状动脉内注入氟碳乳剂或不注入（对照）的情况。通过对左心室压力进行高保真微测压来评估整体收缩和舒张功能。分析了18对球囊充气情况（氟碳乳剂组与对照组）。与对照组相比，患者在注入氟碳乳剂时报告的胸痛严重程度明显减轻。然而，在冠状动脉球囊闭塞期间，氟碳乳剂组和对照组在心室舒张方面，包括早期心室舒张时间常数（tau）和左心室压力最大下降速率（最大负dP/dt），与基线值相比没有显著差异。在球囊充气期间，氟碳乳剂组和对照组在舒张末期压力升高或最小舒张压方面没有差异。对照组从基线值开始的平均收缩压下降幅度大于氟碳乳剂注入组（-9.0±3.3 mmHg，p = 0.013），但在左心室压力最大上升速率（最大正dP/dt）的变化方面没有观察到显著差异。这些结果表明，在冠状动脉球囊闭塞期间，氟碳乳剂不能维持整体左心室舒张功能，可能是因为其相对于动脉血的氧输送能力有限。
