van der Wall E E, Cats V M, Blokland J A, Bosker H A, Arndt J W, Pauwels E K, Bruschke A V
Department of Cardiology, University Hospital Leiden, The Netherlands.
Am Heart J. 1989 Oct;118(4):655-61. doi: 10.1016/0002-8703(89)90575-9.
In a total group of 56 patients with an acute myocardial infarction who were maximally exercised at predischarge, 20 patients (36%) showed greater than or equal to 1 mm asymptomatic ST-T segment depression during exercise. The site of the infarction was anterior in 12 patients and inferior in eight patients. All 20 patients underwent repeated exercise radionuclide angiography 2 days later, 2 hours following oral intake of 120 mg of diltiazem. Double product was not significantly different before and after diltiazem, both at rest and during exercise. Maximal ST-T depression after diltiazem was reduced from 2.3 +/- 0.8 to 0.7 +/- 0.6 mm (p less than 0.01). Left ventricular (LV) ejection fraction at rest before diltiazem was 54.4 +/- 8.7% and after diltiazem was 56.2 +/- 11.3% (p = NS). During exercise, LV ejection fraction improved after diltiazem from 43.2 +/- 12.2% to 49.8 +/- 10.5% (p less than 0.05). Regional wall motion score (1 = normal, 2 = hypokinetic, 3 = akinetic, 4 = dyskinetic) at rest before diltiazem was 9.6 +/- 2.0 and after diltiazem was 9.1 +/- 1.8 (p = NS). During exercise, regional wall motion score improved after diltiazem from 5.8 +/- 1.3 to 4.3 +/- 1.1 (p less than 0.02). We conclude that silent ischemia occurs in a substantial number of patients after myocardial infarction and that diltiazem has acute beneficial effects on asymptomatic ST-T depression and on global and regional LV function in post-infarction patients with silent ischemia.
在56例急性心肌梗死患者出院前进行极量运动的总体研究中，20例患者（36%）运动期间出现≥1mm无症状ST段压低。梗死部位为前壁者12例，下壁者8例。所有20例患者在口服120mg地尔硫䓬2小时后，于2天后重复进行运动放射性核素血管造影。地尔硫䓬前后静息及运动时的双乘积无显著差异。地尔硫䓬后最大ST段压低从2.3±0.8mm降至0.7±0.6mm（p<0.01）。地尔硫䓬前静息时左心室射血分数为54.4±8.7%，地尔硫䓬后为56.2±11.3%（p=无统计学意义）。运动期间，地尔硫䓬后左心室射血分数从43.2±12.2%提高至49.8±10.5%（p<0.05）。地尔硫䓬前静息时局部室壁运动评分（1=正常，2=运动减弱，3=运动消失，4=运动失调）为9.6±2.0，地尔硫䓬后为9.1±1.8（p=无统计学意义）。运动期间，地尔硫䓬后局部室壁运动评分从5.8±1.3改善至4.3±1.1（p<0.02）。我们得出结论，心肌梗死后相当数量的患者存在无症状性心肌缺血，地尔硫䓬对无症状性ST段压低以及心肌梗死后无症状性心肌缺血患者的整体和局部左心室功能具有急性有益作用。
