Konstam M A, Weiland D S, Conlon T P, Martin T T, Cohen S R, Eichhorn E J, Isner J M, Zile M R, Salem D N
Am J Cardiol. 1987 May 1;59(12):1131-7. doi: 10.1016/0002-9149(87)90861-7.
Previous studies have failed to demonstrate the clinical relevance of radionuclide functional measurements during treatment of congestive heart failure (CHF). In the present study, data derived before and during nitroprusside infusion were analyzed in 16 patients with CHF to compare correlations of changes in left (LV) and right ventricular (RV) radionuclide measurements with simultaneous changes in 8 hemodynamic variables. Nitroprusside infusion decreased systemic artery pressure, pulmonary arterial wedge pressure, pulmonary artery pressure, right atrial pressure, and pulmonary and systemic vascular resistance, and increased cardiac output. Nitroprusside decreased LV and RV end-diastolic and end-systolic volumes and increased LV and RV ejection fraction and stroke volume. Changes in RV volumes exceeded changes in LV volumes. LV radionuclide measurements did not correlate significantly with any hemodynamic measurement except for a weak correlation between changes in LV end-systolic volume and right atrial pressure (r = 0.51). In contrast, the combination of changes in RV end-systolic volume and stroke volume predicted changes in pulmonary artery peak systolic (r = 0.90) and mean (r = 0.89) pressures. Changes in pulmonary arterial wedge pressure correlated with changes in RV end-diastolic (r = 0.78) and end-systolic (r = 0.71) volumes. In conclusion, LV radionuclide measurements are of limited value in predicting hemodynamic responses to vasodilator therapy in CHF, whereas RV volumes are strongly influenced by load changes. Their responses to nitroprusside correlate well with changes in pulmonary artery and pulmonary arterial wedge pressures.
以往的研究未能证明放射性核素功能测量在充血性心力衰竭（CHF）治疗过程中的临床相关性。在本研究中，分析了16例CHF患者在硝普钠输注前及输注过程中获得的数据，以比较左心室（LV）和右心室（RV）放射性核素测量值的变化与8项血流动力学变量同时变化之间的相关性。硝普钠输注降低了体动脉压、肺动脉楔压、肺动脉压、右心房压以及肺和体循环血管阻力，并增加了心输出量。硝普钠降低了LV和RV的舒张末期和收缩末期容积，并增加了LV和RV的射血分数及每搏输出量。RV容积的变化超过了LV容积的变化。LV放射性核素测量值与任何血流动力学测量值均无显著相关性，仅LV收缩末期容积变化与右心房压之间存在微弱相关性（r = 0.51）。相比之下，RV收缩末期容积和每搏输出量的变化组合可预测肺动脉收缩期峰值（r = 0.90）和平均压（r = 0.89）的变化。肺动脉楔压的变化与RV舒张末期（r = 0.78）和收缩末期（r = 0.71）容积的变化相关。总之，LV放射性核素测量在预测CHF患者对血管扩张剂治疗的血流动力学反应方面价值有限，而RV容积受负荷变化的影响较大。它们对硝普钠的反应与肺动脉和肺动脉楔压的变化密切相关。
