Masuyama T, Kodama K, Nakatani S, Nanto S, Kitabatake A, Kamada T
Cardiovascular Division, Osaka Police Hospital, Japan.
J Am Coll Cardiol. 1988 Apr;11(4):744-51. doi: 10.1016/0735-1097(88)90206-9.
To determine the effects of changes in coronary stenosis on left ventricular diastolic filling, diastolic filling was serially examined before and after percutaneous transluminal coronary angioplasty using pulsed Doppler echocardiography in 50 patients with stable exertional angina pectoris. Peak rapid filling velocity and the ratio of peak atrial filling to peak rapid filling velocities were measured from the transmitral flow velocity pattern before and 2 and 9 days after coronary angioplasty. Peak rapid filling velocity increased and the ratio of peak atrial filling to peak rapid filling velocities decreased gradually after coronary angioplasty. The improvement in left ventricular diastolic filling was greater in patients with severe (greater than 90%) coronary stenosis than in patients with mild (less than or equal to 90%) coronary stenosis. In the long-term follow-up period, the improved left ventricular diastolic filling worsened in only 11 patients with marked progression to greater than 90% coronary stenosis. Thus, left ventricular diastolic filling improved gradually after coronary angioplasty, possibly reflecting post-ischemic "stunned" myocardium. Serial examinations of left ventricular diastolic filling with pulsed Doppler echocardiography may be a means of noninvasively assessing the temporal changes in the coronary stenosis and predicting the occurrence of coronary restenosis after coronary angioplasty.
为了确定冠状动脉狭窄程度的变化对左心室舒张期充盈的影响，我们采用脉冲多普勒超声心动图，对50例稳定型劳力性心绞痛患者在经皮腔内冠状动脉成形术前后进行了系列舒张期充盈检查。从冠状动脉成形术前、术后2天和9天的二尖瓣血流速度模式中测量快速充盈峰值速度以及心房充盈峰值与快速充盈峰值速度之比。冠状动脉成形术后，快速充盈峰值速度增加，心房充盈峰值与快速充盈峰值速度之比逐渐降低。严重（大于90%）冠状动脉狭窄患者的左心室舒张期充盈改善程度大于轻度（小于或等于90%）冠状动脉狭窄患者。在长期随访期间，仅11例冠状动脉狭窄明显进展至大于90%的患者左心室舒张期充盈改善情况恶化。因此，冠状动脉成形术后左心室舒张期充盈逐渐改善，这可能反映了缺血后“顿抑”心肌的情况。用脉冲多普勒超声心动图对左心室舒张期充盈进行系列检查可能是一种无创评估冠状动脉狭窄时间变化并预测冠状动脉成形术后冠状动脉再狭窄发生情况的方法。
