Bai H T, Fujitani K, Fukuzaki H
First Department of Internal Medicine, Kobe University School of Medicine, Japan.
Jpn Heart J. 1987 Jul;28(4):479-94. doi: 10.1536/ihj.28.479.
To evaluate ventricular filling and interactions between right and left ventricles in patients with old myocardial infarction, right and left ventricular time-volume curves were analyzed from a cineangiographic study of 10 normal subjects (Group 1), 10 patients with old anterior myocardial infarction (Group 2) and 10 patients with old inferior myocardial infarction (Group 3). Volumes of both ventricles were calculated from each frame over an entire cardiac cycle using Simpson's method. From time-volume curves, peak ejection rates, peak filling rates and atrial kick rates were obtained for both ventricles and these parameters were normalized by end-diastolic volume. All patients were in sinus rhythm with heart rates less than 80 beats/min. There were no significant differences among the 3 groups in end-diastolic pressure of both ventricles and mean pulmonary artery pressure. Left ventricular ejection fractions were significantly lower in Groups 2 and 3 than in Group 1 (p less than 0.001, p less than 0.005, respectively), although there were no significant differences in end-diastolic volume indexes of either ventricle among the 3 groups. Peak left ventricular ejection rate and peak filling rates of the left and right ventricles were lower in Group 2 than in Group 1 (p less than 0.01, p less than 0.05, p less than 0.01, respectively) and peak filling rate of the right ventricle in Group 2 correlated with the peak filling rate of the left ventricle and left ventricular ejection fraction (r = 0.64, r = 0.64, respectively). Peak filling rate of the right ventricle in Group 2 correlated inversely with left ventricular peak negative dp/dt (r = -0.72), but no correlation was found between peak filling rate of the right ventricle and left ventricular end-diastolic volume index or mean pulmonary artery pressure. Peak ejection rate of the left ventricle and peak filling rates of both ventricles in Group 3 were lower than in Group 1 (p less than 0.02, p less than 0.02, p less than 0.01, respectively) and no correlation was found between peak filling rates of both ventricles. Wall motion of the right ventricular septal portion was slightly reduced in 5 patients in Group 2. In all patients in Group 3, right ventricular wall motion centering around the right ventricular diaphragmatic portion was reduced. These results suggest that in old inferior myocardial infarction, right ventricular wall motion abnormality results in impaired right ventricular filling, whereas in old anterior myocardial infarction, right ventricular filling is reduced indirectly due to impaired left ventricular filling.
为评估陈旧性心肌梗死患者的心室充盈及左右心室之间的相互作用，对10名正常受试者（第1组）、10名陈旧性前壁心肌梗死患者（第2组）和10名陈旧性下壁心肌梗死患者（第3组）进行了心血管造影研究，分析了左右心室的时间-容积曲线。使用辛普森法则从整个心动周期的每一帧计算两个心室的容积。从时间-容积曲线获取两个心室的峰值射血率、峰值充盈率和心房收缩率，并将这些参数用舒张末期容积进行标准化。所有患者均为窦性心律，心率小于80次/分钟。三组患者的左右心室舒张末期压力和平均肺动脉压无显著差异。第2组和第3组的左心室射血分数显著低于第1组（分别为p<0.001，p<0.005），尽管三组中任一心室的舒张末期容积指数无显著差异。第2组的左心室峰值射血率以及左右心室的峰值充盈率均低于第1组（分别为p<0.01，p<0.05，p<0.01），且第2组右心室的峰值充盈率与左心室的峰值充盈率及左心室射血分数相关（分别为r=0.64，r=0.64）。第2组右心室的峰值充盈率与左心室峰值负dp/dt呈负相关（r=-0.72），但右心室的峰值充盈率与左心室舒张末期容积指数或平均肺动脉压之间未发现相关性。第3组的左心室峰值射血率以及左右心室的峰值充盈率均低于第1组（分别为p<0.02，p<0.02，p<0.01），且两个心室的峰值充盈率之间未发现相关性。第2组有5例患者右心室间隔部分的壁运动略有减弱。第3组所有患者中，以右心室膈面部分为中心的右心室壁运动减弱。这些结果表明，在陈旧性下壁心肌梗死中，右心室壁运动异常导致右心室充盈受损，而在陈旧性前壁心肌梗死中，右心室充盈因左心室充盈受损而间接降低。
