Kass D A, Midei M, Brinker J, Maughan W L
Division of Cardiology, Johns Hopkins Medical Institutions, Baltimore, Maryland 21205.
Circulation. 1990 Feb;81(2):447-60. doi: 10.1161/01.cir.81.2.447.
The influence of acute coronary occlusion on systolic and diastolic left ventricular pressure-volume relations was studied in 10 patients undergoing percutaneous transluminal coronary angioplasty (PTCA). Pressure-volume relations were obtained by conductance catheter and micromanometer techniques and with volume load altered by transient inferior vena caval occlusion. End-systolic and end-diastolic pressure-volume relations were obtained at baseline, during 60-90 seconds of ischemia, and at return to baseline after angioplasty balloon deflation. Coronary occlusion significantly altered systolic and diastolic chamber function. Systolic dysfunction was characterized by a reproducible rightward shift of the end-systolic pressure-volume relation (+25.4 +/- 18.4 ml) that was greater for proximal left anterior descending and circumflex coronary artery occlusions (+41 ml) than for distal or right coronary artery occlusions (+15.4 ml, p less than 0.05). Occlusion also lowered chamber systolic function indexes, such as the end-systolic pressure-volume relation slope (from 4.2 to 2.8 mm Hg/ml) and preload recruitable stroke work (from 97 to 78.6 mm Hg). All systolic (and diastolic) changes were resolved with successful angioplasty. Diastolic abnormalities during angioplasty were characterized by prolonged pressure relaxation and an upward shift of the resting diastolic pressure-volume data and by an apparent increase in chamber elastic stiffness. However, when end-diastolic data from multiple beats during inferior vena caval occlusion were compared, control and ischemic end-diastolic pressure-volume relations displayed little or no difference. Thus, elevations in resting diastolic pressure-volume relations and apparent increase in chamber elastic stiffness during coronary occlusion in humans appear dominated by altered right ventricular or pericardial loading. These data indicate that pressure-volume analysis is useful in assessing the functional significance of coronary lesions and reperfusion.
在10例接受经皮腔内冠状动脉成形术（PTCA）的患者中，研究了急性冠状动脉闭塞对左心室收缩期和舒张期压力-容积关系的影响。通过电导导管和微测压技术获得压力-容积关系，并通过短暂下腔静脉闭塞改变容量负荷。在基线、缺血60 - 90秒期间以及血管成形术球囊放气后恢复到基线时，获得收缩末期和舒张末期压力-容积关系。冠状动脉闭塞显著改变了收缩期和舒张期心室功能。收缩功能障碍的特征是收缩末期压力-容积关系可重复地向右移位（+25.4±18.4 ml），左前降支近端和回旋支冠状动脉闭塞时移位更大（+41 ml），而远端或右冠状动脉闭塞时移位较小（+15.4 ml，p<0.05）。闭塞还降低了心室收缩功能指标，如收缩末期压力-容积关系斜率（从4.2降至2.8 mmHg/ml）和可招募的前负荷搏功（从97降至78.6 mmHg）。成功的血管成形术可解决所有收缩期（和舒张期）变化。血管成形术期间的舒张期异常表现为压力松弛延长、静息舒张期压力-容积数据向上移位以及心室弹性硬度明显增加。然而，当比较下腔静脉闭塞期间多个心动周期的舒张末期数据时，对照和缺血性舒张末期压力-容积关系几乎没有差异。因此，在人类冠状动脉闭塞期间，静息舒张期压力-容积关系升高和心室弹性硬度明显增加似乎主要由右心室或心包负荷改变所致。这些数据表明，压力-容积分析有助于评估冠状动脉病变和再灌注的功能意义。
