Schneider R M, Weintraub W S, Klein L W, Seelaus P A, Agarwal J B, Helfant R H
Am J Cardiol. 1986 Apr 15;57(11):927-32. doi: 10.1016/0002-9149(86)90732-0.
To characterize determinants of the rate of recovery of left ventricular (LV) function after exercise-induced ischemia, sequential postexercise radionuclide angiography was performed prospectively in 38 consecutive patients with documented coronary artery disease (CAD). In each patient new or increased regional asynergy developed or absolute ejection fraction decreased at least 4% during exercise. Twenty patients showed immediate recovery of LV function after exercise (group 1) and 18 showed delayed recovery (group 2). Ejection fraction in the first postexercise period was significantly greater in group 1 (65 +/- 12%) than in group 2 (55 +/- 11%) (p less than 0.01). The mean number of coronary arteries with at least 70% diameter narrowing was greater in group 2 (2.7 +/- 0.5) than in group 1 (2.0 +/- 0.9) (p = 0.026); CAD score was also greater in group 2 than in group 1 (p = 0.005). The increase in LV end-diastolic volume from rest to end exercise was greater in group 2 than in group 1 (p = 0.005); neither the change in LV volume nor the change in heart rate or blood pressure after exercise separated the groups. The only independent predictor of the rate of functional recovery was the degree of exercise-induced regional myocardial asynergy (p less than 0.001). Thus, exercise radionuclide angiography in patients with CAD provides a model for evaluating postischemic myocardial function. Delayed functional recovery is associated with extensive exercise-induced regional asynergy as a result of severe CAD and is not primarily influenced by hemodynamic changes.
为了明确运动诱发心肌缺血后左心室（LV）功能恢复速率的决定因素，我们对38例有冠状动脉疾病（CAD）记录的连续患者进行了前瞻性运动后序贯放射性核素血管造影。每位患者在运动期间出现新的或加重的局部运动不协调，或绝对射血分数至少降低4%。20例患者运动后LV功能立即恢复（第1组），18例患者恢复延迟（第2组）。运动后第一个时期第1组的射血分数（65±12%）显著高于第2组（55±11%）（p<0.01）。第2组至少有70%管径狭窄的冠状动脉平均数量（2.7±0.5）多于第1组（2.0±0.9）（p=0.026）；第2组的CAD评分也高于第1组（p=0.005）。从静息到运动结束LV舒张末期容积的增加第2组大于第1组（p=0.005）；运动后LV容积的变化、心率或血压的变化均未将两组区分开。功能恢复速率的唯一独立预测因素是运动诱发的局部心肌运动不协调程度（p<0.001）。因此，CAD患者的运动放射性核素血管造影为评估缺血后心肌功能提供了一个模型。功能恢复延迟与严重CAD导致的广泛运动诱发局部运动不协调有关，且主要不受血流动力学变化的影响。
