Keren G, Bier A, LeJemtel T H
Can J Cardiol. 1986 Jul-Aug;2(4):206-11.
Left ventricular volumes and forward aortic flow were measured using combined two-dimensional echocardiography and doppler cardiography in seven patients with decompensated congestive heart failure and functional mitral regurgitation prior to and during intravenous administration of nitroglycerin. Total stroke volume was calculated from the difference between end-diastolic and end-systolic volumes, and regurgitant mitral volume from the difference between total stroke volume and forward aortic flow. Regurgitant mitral volume fell from 19 +/- 9 to 3 +/- 3 mL/beat (p less than 0.001), while forward stroke volume increased from 35 +/- 8 to 45 +/- 9 mL/beat (p less than 0.001). The changes were well correlated (r = 0.8, p less than 0.001). Total stroke volume decreased from 54 +/- 12 to 48 +/- 6 mL/beat (p less than 0.05), and ventricular end-diastolic volume from 173 +/- 66 to 158 +/- 66 mL (p less than 0.05). Left ventricular ejection fraction did not change significantly: 33 +/- 9% vs 32 +/- 9% (NS). Thus, in patients with severe congestive heart failure and functional mitral regurgitation, intravenous nitroglycerin redistributes blood flow within the heart by decreasing mitral regurgitation and increasing forward aortic flow, without affecting left ventricular ejection fraction.
在7例失代偿性充血性心力衰竭合并功能性二尖瓣反流患者中，于静脉注射硝酸甘油前及注射过程中，采用二维超声心动图和多普勒心动图联合测量左心室容积及主动脉前向血流。总心搏量由舒张末期容积与收缩末期容积之差计算得出，二尖瓣反流容积由总心搏量与主动脉前向血流之差计算得出。二尖瓣反流容积从19±9降至3±3ml/次心跳（p<0.001），而前向心搏量从35±8增至45±9ml/次心跳（p<0.001）。这些变化具有良好的相关性（r=0.8，p<0.001）。总心搏量从54±12降至48±6ml/次心跳（p<0.05），心室舒张末期容积从173±66降至158±66ml（p<0.05）。左心室射血分数无显著变化：分别为33±9%和32±9%（无显著性差异）。因此，在重度充血性心力衰竭合并功能性二尖瓣反流患者中，静脉注射硝酸甘油通过减少二尖瓣反流和增加主动脉前向血流来重新分配心脏内的血流，而不影响左心室射血分数。
