Caidahl K, Svärdsudd K, Eriksson H, Wilhelmsen L
Am J Cardiol. 1987 Jun 1;59(15):1277-82. doi: 10.1016/0002-9149(87)90904-0.
Dyspnea, a potential early symptom of coronary artery disease and congestive heart failure, was evaluated to establish its relation to left ventricular wall motion abnormalities. A group of 67-year-old men, drawn from the general population of Gothenburg, Sweden, was studied. Acceptable studies by 2-dimensional echocardiography were obtained from 42 of 49 men with dyspnea of presumed cardiac origin, and from 45 randomly selected nondyspneic control subjects. Both groups originated from a random population sample of 644 men. All men with akinesia, not limited to the basal inferolateral segment, were dyspneic. Akinesia (inferolateral segment only) was found in 4 of 45 control subjects (9%). Six of 20 men (30%) with low-grade dyspnea and 5 of 5 men with the most severe grade of dyspnea had 1 or more akinetic segments. The severity of dyspnea was related to regional wall motion disturbances (as classified in 11 anatomic segments [p less than 0.02 to p less than 0.0001]) and to presence and number of akinetic segments (p less than 0.0001). The degree of dyspnea was correlated to anterior (p less than 0.0001) but not inferior akinesia. The regional wall motion disturbances measured by echocardiography still contributed significantly to the explanation of dyspnea when taking into account the presence or absence of clinical coronary artery disease determined from a 12-lead electrocardiogram, the history of angina pectoris and myocardial infarction, and the findings on chest x-ray films. Thus, presumed cardiac dyspnea is a sensitive marker of regional wall motion disturbances. Furthermore, the location of these disturbances may be of importance for the hemodynamic changes leading to cardiac dyspnea.
呼吸困难是冠状动脉疾病和充血性心力衰竭的一种潜在早期症状，本研究对其与左心室壁运动异常的关系进行了评估。研究对象为一组来自瑞典哥德堡普通人群的67岁男性。在49名推测为心脏源性呼吸困难的男性中，42人通过二维超声心动图获得了可接受的检查结果；同时从45名随机选取的无呼吸困难的对照受试者中也获得了可接受的检查结果。这两组均来自644名男性的随机人群样本。所有存在运动不能（不仅限于基底段下外侧）的男性均有呼吸困难症状。在45名对照受试者中有4人（9%）存在运动不能（仅下外侧段）。在20名轻度呼吸困难男性中有6人（30%），以及在5名最严重程度呼吸困难男性中有5人存在1个或更多运动不能节段。呼吸困难的严重程度与局部壁运动障碍（按11个解剖节段分类，p<0.02至p<0.0001）以及运动不能节段的存在和数量（p<0.0001）相关。呼吸困难的程度与前壁运动不能相关（p<0.0001），但与下壁运动不能无关。当考虑到根据12导联心电图确定的临床冠状动脉疾病的有无、心绞痛和心肌梗死病史以及胸部X线片检查结果时，超声心动图测量的局部壁运动障碍对呼吸困难的解释仍有显著贡献。因此，推测为心脏源性的呼吸困难是局部壁运动障碍的一个敏感指标。此外，这些障碍的位置对于导致心脏源性呼吸困难的血流动力学变化可能很重要。
