Laskey W K, Zeevi G R, Sutton M S, Martin J L, Hirshfeld J W, Reichek N
Am Heart J. 1986 Nov;112(5):953-62. doi: 10.1016/0002-8703(86)90306-6.
The coronary hemodynamic and left ventricular mechanical responses to nitroglycerin were studied in eight patients with angina, normal coronary arteries, and pressure overload left ventricular hypertrophy (POLVH) and in five control subjects. Elevated mean and end-diastolic pressure and end-diastolic meridional stress characterized the POLVH group, although systolic meridional stresses were not significantly different from the control group. Thermodilution coronary sinus flow and estimated myocardial oxygen consumption declined significantly following nitroglycerin in both patient groups. Systolic and diastolic mechanical loads also decreased in both groups, although diastolic tone remained elevated in the patients with POLVH. The decrease in coronary sinus flow in the POLVH group was in excess of that expected from the decrease in systolic mechanical load, which suggests a combination of perfusion pressure-dependent decreases in coronary flow as well as an increased resistance to coronary inflow in these patients. The beneficial clinical response to nitroglycerin may reflect the lowered myocardial metabolic demand as well as the decrease in diastolic myocardial tensile and compressive forces.
对8例患有心绞痛、冠状动脉正常且存在压力超负荷性左心室肥厚（POLVH）的患者以及5名对照受试者，研究了硝酸甘油对冠状动脉血流动力学和左心室力学的影响。POLVH组的平均舒张压和舒张末期压力以及舒张末期经向应力升高，尽管收缩期经向应力与对照组无显著差异。两组患者在使用硝酸甘油后，热稀释法测定的冠状窦血流量和估计的心肌耗氧量均显著下降。两组的收缩期和舒张期机械负荷也均降低，尽管POLVH患者的舒张期张力仍升高。POLVH组冠状窦血流量的减少超过了收缩期机械负荷降低所预期的减少量，这表明这些患者中冠状动脉血流量的减少既有灌注压力依赖性因素，也有冠状动脉流入阻力增加的因素。硝酸甘油的有益临床反应可能反映了心肌代谢需求的降低以及舒张期心肌拉伸和压缩力的减少。
