Pfisterer M, Regenass S, Müller-Brand J, Burkart F
Division of Cardiology, University Hospital, Basel, Switzerland.
Eur Heart J. 1988 Dec;9 Suppl N:98-103. doi: 10.1093/eurheartj/9.suppl_n.98.
Demonstration of ischaemic left ventricular dysfunction in the absence of chest pain should provide important confirmation of silent myocardial ischaemia in patients with asymptomatic ST segment changes. For this purpose, a new portable scintillation probe (VEST) similar to a miniaturized nuclear stethoscope combined with a Holter ECG was evaluated. After standard equilibrium radionuclide angiocardiography with technetium-99m labelled red blood cells, the VEST was positioned under gamma-camera control and data were recorded from 1-12 h in 61 unselected patients. Ejection fraction (LVEF), relative changes in volumes, heart rate and ST segment changes were determined. Reproducibility of LVEF at rest (r = 0.91; variability 3.8 +/- 3%, N = 19) and during exercise (r = 0.98; variability 3.2 +/- 2%, N = 19) was good. In 15 asymptomatic exercise tests four different patterns of LVEF and ST segment responses were identified: (1) decrease in LVEF followed by significant ST depression (five times); (2) ST depression followed by decrease in LVEF (three times); (3) decrease in LVEF without significant ST changes (three times); and (4) ST depression without significant LVEF change (four times). In this still small series, patterns (1) to (3) corresponded to patients with documented coronary artery disease, which was not the case for pattern (4). For detection of silent ischaemia at rest, a decrease in LVEF of greater than 5% lasting for greater than 1 min was defined as ischaemic LV dysfunction. Using this definition, four spontaneous episodes of silent LV dysfunction could be demonstrated in two of three CCU patients with unstable angina during 160-680 min of data recordings without simultaneous ST changes.(ABSTRACT TRUNCATED AT 250 WORDS)
在无胸痛情况下证实存在缺血性左心室功能障碍，对于无症状ST段改变患者的无症状心肌缺血具有重要的确诊意义。为此，对一种类似于小型核听诊器并结合动态心电图的新型便携式闪烁探头（VEST）进行了评估。在用99m锝标记的红细胞进行标准平衡放射性核素血管造影后，将VEST在γ相机控制下定位，并在61例未经挑选的患者中记录1至12小时的数据。测定射血分数（LVEF）、容积相对变化、心率和ST段变化。静息时LVEF的重复性良好（r = 0.91；变异性3.8±3%，N = 19），运动时LVEF的重复性也良好（r = 0.98；变异性3.2±2%，N = 19）。在15次无症状运动试验中，识别出四种不同的LVEF和ST段反应模式：（1）LVEF降低后出现显著ST段压低（5次）；（2）ST段压低后LVEF降低（3次）；（3）LVEF降低但无显著ST段变化（3次）；（4）ST段压低但无显著LVEF变化（4次）。在这个规模仍然较小的系列研究中，模式（1）至（3）对应有记录的冠状动脉疾病患者，而模式（4）并非如此。对于静息时无症状缺血的检测，将LVEF降低超过5%且持续超过1分钟定义为缺血性左心室功能障碍。采用这个定义，在3例不稳定型心绞痛CCU患者中的2例患者在160至680分钟的数据记录期间，可证实有4次无症状左心室功能障碍的自发发作，且同时无ST段变化。（摘要截断于250字）
