Schaefer S, Malloy C R, Schmitz J M, Dehmer G J
Cardiac Catheterization Laboratory, Dallas Veterans Administration Medical Center, TX 75216.
Am Heart J. 1988 Jun;115(6):1251-7. doi: 10.1016/0002-8703(88)90017-8.
Pulsus alternans can be found in some patients with abnormal left ventricular function and also can develop after spontaneous premature beats. The purposes of this study were to: (1) determine the inducibility of pulsus alternans in a series of patients referred for routine cardiac catheterization and (2) define the clinical and hemodynamic characteristics of those who develop pulsus alternans. In 104 patients referred for right and left heart catheterization, atrial premature beats and rapid atrial pacing were used to try to provoke pulsus alternans. The 29 patients who developed pulsus alternans in response to these maneuvers were older (63 +/- 6 vs 59 +/- 10 years, p less than 0.01) and had a greater incidence of valvular heart disease (45% vs 23%, p less than 0.01) and congestive heart failure (38% vs 17%, p less than 0.05). Aortic stenosis was the most prevalent valve lesion found. Those who developed pulsus alternans in response to pacing were further characterized by higher left ventricular systolic (143 +/- 42 vs 121 +/- 23 mm Hg, p less than 0.02) and end-diastolic pressures (17 +/- 9 vs 13 +/- 6 mm Hg, p less than 0.05), higher pulmonary artery systolic pressure (35 +/- 14 vs 29 +/- 11 mm Hg, p less than 0.04), and lower left ventricular ejection fractions (0.42 +/- 0.13 vs 0.53 +/- 0.14, p less than 0.001). Eight patients (28%) with inducible pulsus alternans had a normal left ventricular ejection fraction (greater than 0.50) and left ventricular end-diastolic pressure (less than 13 mm Hg).(ABSTRACT TRUNCATED AT 250 WORDS)
交替脉可见于一些左心室功能异常的患者，也可在自发性早搏后出现。本研究的目的是：（1）确定一系列因常规心脏导管检查就诊的患者中交替脉的可诱导性；（2）明确出现交替脉患者的临床和血流动力学特征。在104例接受左右心导管检查的患者中，采用房性早搏和快速心房起搏试图诱发交替脉。因这些操作而出现交替脉的29例患者年龄较大（63±6岁 vs 59±10岁，p<0.01），瓣膜性心脏病发生率更高（45% vs 23%，p<0.01），充血性心力衰竭发生率更高（38% vs 17%，p<0.05）。主动脉瓣狭窄是最常见的瓣膜病变。因起搏而出现交替脉的患者进一步表现为左心室收缩压更高（143±42 vs 121±23 mmHg，p<0.02）和舒张末期压力更高（17±9 vs 13±6 mmHg，p<0.05），肺动脉收缩压更高（35±14 vs 29±11 mmHg，p<0.04），以及左心室射血分数更低（0.42±0.13 vs 0.53±0.14，p<0.001）。8例（28%）可诱导出交替脉的患者左心室射血分数正常（>0.50）且左心室舒张末期压力正常（<13 mmHg）。（摘要截断于250字）
