Kaul S, Pandian N G, Gillam L D, Newell J B, Okada R D, Weyman A E
J Am Coll Cardiol. 1986 Feb;7(2):383-92. doi: 10.1016/s0735-1097(86)80509-5.
To define the in vivo relation between abnormal wall motion and the area at risk for necrosis after acute coronary occlusion, 11 open chest dogs were studied. Five dogs underwent left anterior descending coronary artery occlusion and six underwent left circumflex artery occlusion. Area at risk was defined at five short-axis levels (mitral valve, chordal, high and low papillary muscle and apex) using myocardial contrast echocardiography. Wall motion was measured in the cycles preceding injection of contrast medium. Two observers used two different methods to measure wall motion. In method A, end-diastolic to end-systolic fractional radial change for each of 32 endocardial targets was determined. The extent of abnormal wall motion was then calculated using three definitions of wall motion abnormality: akinesia/dyskinesia, fractional inward endocardial excursion of less than 10%, and fractional inward endocardial excursion of less than 20%. In method B, the information from the entire systolic contraction sequence was analyzed and correlated with a normal contraction pattern. The best linear correlation between area at risk (AR) and abnormal wall motion (AWM) was achieved using method B and expressed by the following linear regression: AWM = 0.92 AR + 3.0 (r = 0.92, p less than 0.0001, SEE = 1.7%). Of the three definitions of abnormality used in method A, the best correlation was achieved between area at risk and less than 10% inward endocardial excursion and was expressed by the following polynomial regression: AWM = -0.01 AR2 + 1.5 AR -0.14 (r = 0.92, p less than 0.001, SEE = 1.7%). These data demonstrate that there is a definite relation between area at risk and abnormal wall motion but that this relation varies depending on the method used to analyze wall motion. However, wall motion during acute ischemia is also influenced by the loading conditions of the heart. Because these may vary in a manner that is independent of the ischemic process, measurement of both risk area and abnormal motion may provide a more comprehensive assessment of cardiac function in myocardial ischemia than is provided by the measurement of either alone.
为了确定急性冠状动脉闭塞后异常室壁运动与坏死危险区域之间的体内关系，对11只开胸犬进行了研究。5只犬接受左前降支冠状动脉闭塞，6只犬接受左旋支动脉闭塞。使用心肌对比超声心动图在五个短轴水平（二尖瓣、腱索、高低乳头肌和心尖）确定危险区域。在注射造影剂之前的心动周期中测量室壁运动。两名观察者使用两种不同方法测量室壁运动。在方法A中，确定32个心内膜靶点中每个靶点的舒张末期至收缩末期径向分数变化。然后使用室壁运动异常的三种定义计算异常室壁运动的程度：运动不能/运动障碍、心内膜向内偏移分数小于10%以及心内膜向内偏移分数小于20%。在方法B中，分析整个收缩期收缩序列的信息并与正常收缩模式相关联。使用方法B实现了危险区域（AR）与异常室壁运动（AWM）之间的最佳线性相关性，并由以下线性回归表示：AWM = 0.92AR + 3.0（r = 0.92，p小于0.0001，标准误 = 1.7%）。在方法A中使用的三种异常定义中，危险区域与心内膜向内偏移小于10%之间实现了最佳相关性，并由以下多项式回归表示：AWM = -0.01AR² + 1.5AR - 0.14（r = 0.92，p小于0.001，标准误 = 1.7%）。这些数据表明，危险区域与异常室壁运动之间存在明确关系，但这种关系因分析室壁运动的方法而异。然而，急性缺血期间的室壁运动也受心脏负荷状态的影响。由于这些可能以独立于缺血过程的方式变化，与单独测量二者之一相比，同时测量危险区域和异常运动可能为心肌缺血时的心功能提供更全面的评估。
