Thein Paul M, Mirzaee Sam, Cameron James D, Nasis Arthur
Monash Cardiovascular Research Centre, MonashHEART, Monash Health, Monash University, Melbourne, Victoria, Australia.
Intern Med J. 2022 Feb;52(2):186-197. doi: 10.1111/imj.14995. Epub 2022 Jan 11.
An abnormal left ventricular contractile reserve is often seen in patients undergoing stress echocardiogram and may indicate the presence of obstructive coronary artery disease. The techniques and indexes used to identify abnormal left ventricular contractile response and its prognostic value in the absence of known causes has not been well studied. To describe the characteristics and clinical outcomes associated with an abnormal left ventricular contractile response, we performed a systematic review that identified 27 eligible studies. A diverse range of indices were utilised to measure left ventricular contractile reserve, most commonly Δleft ventricular ejection fraction in 11 studies. Dobutamine stress echocardiogram was the most commonly performed modality (19 studies) followed by exercise stress echocardiogram (4 studies), dipyridamole stress echocardiogram (2 studies), invasive hemodynamic measurement (1 study) and dobutamine stress magnetic resonance imaging (1 study). All but one study demonstrated a significant association between the absence of left ventricular contractile reserve and increased rate of cardiovascular events, cardiac death and all-cause mortality.
在接受负荷超声心动图检查的患者中，常可见左心室收缩储备异常，这可能提示存在阻塞性冠状动脉疾病。用于识别左心室收缩反应异常的技术和指标及其在无已知病因情况下的预后价值尚未得到充分研究。为了描述与左心室收缩反应异常相关的特征和临床结局，我们进行了一项系统评价，确定了27项符合条件的研究。使用了多种指标来测量左心室收缩储备，11项研究中最常用的是左心室射血分数变化值。多巴酚丁胺负荷超声心动图是最常用的检查方式（19项研究），其次是运动负荷超声心动图（4项研究）、双嘧达莫负荷超声心动图（2项研究）、有创血流动力学测量（1项研究）和多巴酚丁胺负荷磁共振成像（1项研究）。除一项研究外，所有研究均表明左心室收缩储备缺失与心血管事件、心源性死亡和全因死亡率增加之间存在显著关联。
