Bassand J P, Ducellier D, Lusson J R, Peycelon P, Faivre R, Cardot J C, Cassagnes J, Jallut J, Maurat J P
Hopital Saint Jacques, Besancon, France.
Eur Heart J. 1988 Apr;9 Suppl E:87-92. doi: 10.1093/eurheartj/9.suppl_e.87.
The left ventricular volumes, the left ventricular ejection fraction, the stroke volume index and the cardiac index were non-invasively determined in 47 patients suffering from moderate to severe pure aortic stenosis using radionuclide angiography at rest and at peak supine exercise. Each patient was previously submitted to right and left heart catheterization and to selective coronary angiography. The left ventricular ejection fraction decreased significantly during exercise (0.62 +/- 0.09 to 0.59 +/- 0.09, P less than 0.01). End-systolic volume, end-diastolic volume, stroke volume index and cardiac index increased significantly. The stroke volume variations were linked to the end-diastolic volume variations by a strong relationship (r = 0.84, P less than 0.001) and to left ventricular mass by a weak, but significant, inverse relationship (r = -0.42, P less than 0.05). No relation existed between stroke volume index variations and any other variables, particularly systolic gradient, aortic valve area and resting left ventricular ejection fraction. The results suggest that, in aortic stenosis, the adaptation of the left ventricular pump function during exercise is mostly dependent upon the diastolic properties of the left ventricular wall and is limited by the progression of left ventricular hypertrophy, i.e. diastolic stiffness. By contrast, the role of the basal systolic pump function and of the severity of the valvular obstruction seems of limited importance.
对47例中重度单纯主动脉瓣狭窄患者在静息和仰卧位运动高峰时采用放射性核素血管造影术无创测定左心室容积、左心室射血分数、每搏量指数和心指数。每位患者此前均接受过左右心导管检查和选择性冠状动脉造影。运动期间左心室射血分数显著降低（从0.62±0.09降至0.59±0.09，P＜0.01）。收缩末期容积、舒张末期容积、每搏量指数和心指数显著增加。每搏量变化与舒张末期容积变化之间存在强相关性（r = 0.84，P＜0.001），与左心室质量存在弱但显著的负相关性（r = -0.42，P＜0.05）。每搏量指数变化与任何其他变量之间均无关联，尤其是收缩期压力阶差、主动脉瓣面积和静息左心室射血分数。结果表明，在主动脉瓣狭窄中，运动期间左心室泵功能的适应主要取决于左心室壁的舒张特性，并受左心室肥厚进展即舒张期僵硬度的限制。相比之下，基础收缩期泵功能和瓣膜梗阻严重程度的作用似乎有限。
