Noma S, Askenase A D, Agarwal J B, Helfant R H
Philadelphia Heart Institute, Presbyterian-University of Pennsylvania Medical Center.
Am Heart J. 1988 Dec;116(6 Pt 1):1536-41. doi: 10.1016/0002-8703(88)90740-5.
Regional function assessed by ventriculography may be influenced by the hemodynamic effects of rapidly injecting ionic contrast medium. The importance of this after acute coronary occlusion was examined in eight open-chest, anesthetized dogs. The left anterior descending artery was ligated while sonomicrometric segment lengths in the ischemic (IZ) and nonischemic zones (NZ) were measured. Sodium methylglucamine diatrizoate (Renografin-76, 1 ml/kg) was rapidly injected over 3 seconds. Fifteen minutes later, the left ventricular end-diastolic pressure (LVEDP) was rapidly increased to the level reached during injection. Injecting the contrast increased the LVEDP (7.3 +/- 2.5 to 20.1 +/- 2.9 mm Hg, p less than 0.0001) to the same extent as raising LVEDP (7.6 +/- 2.5 to 10.1 +/- 2.9 mm Hg, p less than 0.0001). Injecting the contrast medium increased IZ total percent systolic shortening (% delta L) (-3.90 +/- 4.43% to -2.68 +/- 4.77%, p less than 0.001) by decreasing isovolumic bulging (-6.68 +/- 4.09% to -5.49 +/- 3.33%, p less than 0.001) with little change in ejection % delta L. NZ total % delta L tended to increase (19.03 +/- 6.53% to 19.94 +/- 6.27%, p = 0.015) because of augmented ejection % delta L (13.12 +/- 2.51% to 13.71 +/- 3.10%, p = 0.017) by the Starling mechanism. Increasing the LVEDP had the same effect on IZ and NZ regional shortening as injecting contrast. Thus regional shortening after acute coronary occlusion is affected by the changes in loading conditions with ionic contrast ventriculography.(ABSTRACT TRUNCATED AT 250 WORDS)
通过心室造影评估的局部功能可能会受到快速注射离子型造影剂的血流动力学效应的影响。在八只开胸麻醉的狗身上研究了急性冠状动脉闭塞后这种影响的重要性。结扎左前降支动脉,同时测量缺血区(IZ)和非缺血区(NZ)的声控测微线段长度。在3秒内快速注射葡甲胺酸钠泛影葡胺(泛影葡胺-76,1 ml/kg)。15分钟后,将左心室舒张末期压力(LVEDP)迅速升高至注射期间达到的水平。注射造影剂使LVEDP升高(从7.3±2.5至20.1±2.9 mmHg,p<0.0001),与升高LVEDP(从7.6±2.5至10.1±2.9 mmHg,p<0.0001)的程度相同。注射造影剂通过减少等容性膨出(从-6.68±4.09%至-5.49±3.33%,p<0.001)使IZ总收缩期缩短百分比(%ΔL)增加(从-3.90±4.43%至-2.68±4.77%,p<0.001),而射血%ΔL变化不大。由于通过Starling机制使射血%ΔL增加(从13.12±2.51%至13.71±3.10%,p = 0.017),NZ总%ΔL有增加趋势(从19.03±6.53%至19.94±6.27%,p = 0.015)。升高LVEDP对IZ和NZ局部缩短的影响与注射造影剂相同。因此,急性冠状动脉闭塞后的局部缩短受离子型造影剂心室造影时负荷条件变化的影响。(摘要截短至250字)