Inagaki S, Adachi H, Sugihara H, Nakagawa H, Kubota Y, Furukawa K, Asayama J, Katsume H, Ijichi H, Mochizuki S
Second Department of Internal Medicine, Kyoto Prefectural University of Medicine.
J Cardiogr. 1986 Dec;16(4):949-61.
Cardiac function is difficult to assess in patients with atrial fibrillation due to the widely fluctuating cycle lengths resulting in variable ventricular hemodynamics. With respect to ECG-gated blood pool scintigraphy, distortion of the time activity curve occurs due to a summation of irregular cycle lengths. Therefore, performing such a study has been regarded meaningless. To evaluate left ventricular function during atrial fibrillation using scintigraphic technique, a new processing algorithm was devised to make multiple gated images which are discriminated by the preceding R-R interval, and left ventricular filling and function curves were established. The left ventricular filling curve, obtained by plotting end-diastolic volume against the preceding R-R intervals demonstrated an impairment of blood filling in cases of mitral stenosis and constrictive pericarditis, which resolved after mitral commissurotomy in case of mitral stenosis. The left ventricular function curve, established by plotting stroke volume against end-diastolic volume, was analyzed according to indices such as "slope" and "position". Both of these indices were significantly reduced in relation to the severity of heart failure according to the NYHA's functional classification and cardiomegaly on chest radiography. On individual comparisons of underlying diseases, the indices decreased in the following order; lone atrial fibrillation, hyperthyroidism, aging, hypertension, mitral valve disease, ischemic heart disease, dilated cardiomyopathy and aortic regurgitation. The indices correlated closely with ejection fraction. In cases of mitral regurgitation, however, the function curves were situated to the right and above those of lone atrial fibrillation and decreased in slope despite the fairly well-maintained ejection fraction. After treatment with digitalis and/or diuretics, the function curves shifted to the left and upward. In conclusion, left ventricular filling and function curves based on a newly-devised algorithm of ECG-gated blood pool scintigraphy are of considerable clinical value in evaluating cardiac performance in patients with atrial fibrillation. They are widely applicable to the assessment of therapeutic and interventional effects.
由于房颤患者的心动周期长度波动较大，导致心室血流动力学变化不定，因此很难评估其心脏功能。对于心电图门控心血池闪烁显像，由于不规则心动周期长度的总和，时间-活性曲线会发生扭曲。因此，进行这样的研究被认为毫无意义。为了使用闪烁显像技术评估房颤期间的左心室功能，设计了一种新的处理算法来制作多个门控图像，这些图像根据前一个R-R间期进行区分，并建立了左心室充盈和功能曲线。通过将舒张末期容积与前一个R-R间期作图得到的左心室充盈曲线显示，二尖瓣狭窄和缩窄性心包炎患者存在血液充盈受损，二尖瓣狭窄患者在二尖瓣交界切开术后这种情况得到缓解。通过将每搏量与舒张末期容积作图建立的左心室功能曲线，根据“斜率”和“位置”等指标进行分析。根据纽约心脏协会（NYHA）的心功能分级和胸部X线片上的心脏扩大情况，这两个指标均随着心力衰竭的严重程度而显著降低。在对基础疾病进行个体比较时，这些指标按以下顺序降低：孤立性房颤、甲状腺功能亢进、衰老、高血压、二尖瓣疾病、缺血性心脏病、扩张型心肌病和主动脉瓣关闭不全。这些指标与射血分数密切相关。然而，在二尖瓣反流的情况下，功能曲线位于孤立性房颤的右侧和上方，尽管射血分数保持相当良好，但斜率降低。在用洋地黄和/或利尿剂治疗后，功能曲线向左上方移动。总之，基于新设计的心电图门控心血池闪烁显像算法的左心室充盈和功能曲线，在评估房颤患者的心脏功能方面具有相当大的临床价值。它们广泛适用于评估治疗和介入效果。
