Ratner S J, Friedman M I, Pierson R N, Baum M S, Wolinsky D G
Division of Cardiology, St. Luke's-Roosevelt Hospital Center, New York, New York 10025.
Clin Cardiol. 1988 Apr;11(4):239-44. doi: 10.1002/clc.4960110408.
To evaluate the role of analysis of right ventricular function with exercise in patients with presumed coronary artery disease referred for radionuclide ventriculography, the records of 55 patients referred to our laboratory over a 19-month period were reviewed. All underwent rest and exercise first-pass radionuclide stress testing and cardiac catheterization within a period of four months. Three groups were identified: (1) patients with normal exercise right ventricular function (n = 24); (2) patients with exercise-induced right ventricular regional wall motion abnormalities (n = 15); and, (3) patients with abnormal resting right ventricular function without new exercise abnormalities (n = 16). Patients in each group were similar in age, sex, baseline left ventricular function, medication usage, and indication for study. The incidence of right coronary artery disease was identical in the three groups, as was the incidence of left ventricular functional abnormalities with exercise. Patients with proximal right coronary artery disease were more likely to have reduced left ventricular ejection fraction and more extensive coronary artery disease than those without disease at this site. We conclude that: (1) analysis of rest and exercise right ventricular function does not allow prediction of coronary anatomy in an unselected group of patients; (2) normal right ventricular function with exercise is compatible with extensive coronary artery disease, including proximal right coronary artery disease; and (3) abnormal exercise right ventricular function may be due to exertional left ventricular dysfunction in the absence of proximal right coronary artery disease.
为了评估运动时右心室功能分析在因放射性核素心室造影而被转诊的疑似冠心病患者中的作用，我们回顾了在19个月期间转诊至我们实验室的55例患者的记录。所有患者均在四个月内接受了静息和运动首次通过放射性核素负荷试验以及心导管检查。确定了三组：（1）运动时右心室功能正常的患者（n = 24）；（2）运动诱发的右心室局部壁运动异常的患者（n = 15）；以及（3）静息时右心室功能异常但运动时无新异常的患者（n = 16）。每组患者在年龄、性别、基线左心室功能、药物使用情况和研究指征方面相似。三组患者的右冠状动脉疾病发生率相同，运动时左心室功能异常的发生率也相同。与该部位无疾病的患者相比，近端右冠状动脉疾病患者更可能出现左心室射血分数降低和冠状动脉疾病更广泛。我们得出以下结论：（1）对静息和运动时右心室功能的分析无法在未经选择的患者群体中预测冠状动脉解剖结构；（2）运动时右心室功能正常与广泛的冠状动脉疾病兼容，包括近端右冠状动脉疾病；（3）运动时右心室功能异常可能是由于在无近端右冠状动脉疾病的情况下运动性左心室功能障碍所致。
