Kligfield P, Ameisen O, Okin P M, Niles N W, Hochreiter C, Roman M J, Sato N, Devereux R B, Borer J S
Am Heart J. 1987 May;113(5):1097-102. doi: 10.1016/0002-8703(87)90918-5.
The exercise ECGs of 30 patients with pure aortic regurgitation (AR) were compared with functional and geometric variables measured by echocardiography and radionuclide cineangiography. The 10 patients with positive ECG responses to exercise (greater than or equal to 0.1 mV additional downsloping or horizontal ST segment depression) were similar to the 20 patients with negative tests with respect to mean age, exercise duration, peak work load achieved, symptoms, and resting ECG findings. Patients with positive exercise tests had significantly reduced left ventricular (LV) ejection fractions at rest (44 +/- 4% vs 52 +/- 2%) and during peak exercise (38 +/- 3% vs 48 +/- 2%), lower fractional shortening at rest (27 +/- 1% vs 34 +/- 2%), higher end-systolic wall stress (150 +/- 18 vs 99 +/- 8 dynes/cm2 X 10(3], lower left ventricular relative wall thickness (0.26 +/- 0.01 vs 0.30 +/- 0.01), and greater end-systolic diameter (5.7 +/- 0.3 vs 4.5 +/- 0.2 cm) than patients with negative tests (p less than 0.05 for all comparisons). Among the 18 asymptomatic patients, positive tests were associated with lower resting fractional shortening, lower exercise ejection fraction, higher wall stress, and greater end-systolic diameter. These data demonstrate that a positive exercise ECG in aortic regurgitation identifies patients, even when asymptomatic, who have developed markedly abnormal left ventricular functional and geometric responses to volume load, while a negative exercise ECG identifies a subset of asymptomatic patients who are unlikely to have severe ventricular dysfunction.
将30例单纯主动脉瓣反流（AR）患者的运动心电图与通过超声心动图和放射性核素心血管造影测量的功能及几何变量进行比较。10例运动心电图反应阳性（运动时ST段额外下斜或水平压低大于或等于0.1mV）的患者与20例检查结果阴性的患者在平均年龄、运动持续时间、达到的峰值工作量、症状及静息心电图表现方面相似。运动试验阳性的患者静息时左心室（LV）射血分数（44±4%对52±2%）和运动峰值时（38±3%对48±2%）显著降低，静息时缩短分数较低（27±1%对34±2%），收缩末期壁应力较高（150±18对99±8达因/平方厘米×10³），左心室相对壁厚度较低（0.26±0.01对0.30±0.01），收缩末期直径较大（5.7±0.3对4.5±0.2厘米），均低于检查结果阴性的患者（所有比较p均小于0.05）。在18例无症状患者中，试验阳性与静息时较低的缩短分数、较低的运动射血分数、较高的壁应力及较大的收缩末期直径相关。这些数据表明，主动脉瓣反流患者运动心电图阳性可识别出即使无症状但对容量负荷已出现明显异常左心室功能和几何反应的患者，而运动心电图阴性则可识别出不太可能有严重心室功能障碍的无症状患者亚组。
