Sano S, Nawa S, Senoo Y, Teramoto S
Second Department of Surgery, Okayama University Medical School, Japan.
Acta Med Okayama. 1989 Aug;43(4):223-31. doi: 10.18926/AMO/30856.
Dynamic ergometer exercise in a supine position was applied to 64 patients more than 1 year after valvular heart surgery, and the left ventricular reserve was evaluated echocardiographically. The left ventricular reserve declined in the mitral stenosis-mitral valve replacement group, while it was better maintained in the mitral stenosis-mitral commissurotomy, aortic regurgitation and aortic stenosis groups. The patients were divided into 3 groups depending on whether the percentage increase during exercise of stroke index, an index of left ventricular pump function, increased, unchanged, or decreased. The percentage increase of mean velocity of circumferential fibre shortening (y) and that of left ventricular end-diastolic diameter (x) during exercise were plotted for each group. The increased group was isolated from the unchanged group by the line of y = -5.02x + 30.1; the unchanged group was isolated from the decreased group by that of y = -5.68x-10.0, and the increased and unchanged groups were clearly isolated from the decreased group by that of y = -6.86x-4.76. We conclude that dynamic ergometer exercise echocardiography is useful for evaluating the left ventricular reserve of postoperative patients with valvular heart disease. It was also thought that the subclinical state of cardiac failure can be effectively detected by the present method.
对64例心脏瓣膜置换术后1年以上的患者进行了仰卧位动态测力计运动试验，并通过超声心动图评估左心室储备功能。二尖瓣狭窄-二尖瓣置换组左心室储备功能下降，而二尖瓣狭窄-二尖瓣交界切开术、主动脉瓣关闭不全和主动脉瓣狭窄组左心室储备功能保持较好。根据左心室泵功能指标每搏输出指数运动时增加的百分比是增加、不变还是降低，将患者分为3组。为每组绘制运动时圆周纤维缩短平均速度（y）增加百分比和左心室舒张末期直径（x）增加百分比的关系图。增加组与不变组由y = -5.02x + 30.1这条线分隔开；不变组与降低组由y = -5.68x - 10.0这条线分隔开，增加组和不变组与降低组由y = -6.86x - 4.76这条线清晰地分隔开。我们得出结论，动态测力计运动超声心动图对评估心脏瓣膜病术后患者的左心室储备功能是有用的。还认为通过本方法可以有效地检测出心力衰竭的亚临床状态。
