Lew W Y, Chen Z Y, Guth B, Covell J W
Circ Res. 1985 Mar;56(3):351-8. doi: 10.1161/01.res.56.3.351.
To examine the interaction between normal and nonischemic areas of the left ventricle during acute ischemia, we implanted midwall ultrasonic segment length gauges in the ischemic zone and in nonischemic areas of the canine left ventricle. During acute ischemia, end-diastolic pressure and segment length in the nonischemic areas increased. There was no change from control in the segment length at the time of aortic valve opening and closure. Thus, in nonischemic areas, total segment shortening, as measured by the percent change in segment length from the time of end-diastole to aortic valve closure, increased. This was due to an increase in isovolumic shortening (end-diastole to aortic valve opening) with no change in ejection shortening (aortic valve opening to closure). The progressive increase in isovolumic shortening in nonischemic areas over time was directly paralleled by the progressive development of the isovolumic lengthening or bulge in the ischemic zone. Nonischemic areas, whether adjacent, on the opposite wall, or distant to the ischemic zone, all behaved similarly. Adrenergic blockade did not qualitatively alter these findings. We conclude that acute ischemia induces a mechanical disadvantage which is greater than just the loss of contractile function by the ischemic segment. Despite the apparent hyperfunction of nonischemic areas, the increased total segment shortening is expended in stretching the ischemic zone during isovolumic systole. As a result, there is no significant "compensatory" increase in ejection shortening in nonischemic areas.(ABSTRACT TRUNCATED AT 250 WORDS)
为研究急性缺血期间左心室正常区域与非缺血区域之间的相互作用,我们在犬左心室的缺血区和非缺血区植入了室壁中部超声节段长度测量仪。急性缺血期间,非缺血区的舒张末期压力和节段长度增加。主动脉瓣开放和关闭时节段长度与对照相比无变化。因此,在非缺血区,以舒张末期至主动脉瓣关闭时节段长度的变化百分比衡量的节段总缩短增加。这是由于等容收缩期缩短(舒张末期至主动脉瓣开放)增加,而射血期缩短(主动脉瓣开放至关闭)无变化。随着时间推移,非缺血区等容收缩期缩短的逐渐增加与缺血区等容舒张期延长或膨出的逐渐发展直接平行。非缺血区,无论与缺血区相邻、在对侧壁还是距离较远,表现均相似。肾上腺素能阻断并未从质上改变这些发现。我们得出结论,急性缺血导致一种机械性劣势,这种劣势不仅仅是缺血节段收缩功能丧失。尽管非缺血区明显功能亢进,但节段总缩短增加是在等容收缩期用于拉伸缺血区。结果,非缺血区射血期缩短没有显著的“代偿性”增加。(摘要截选至250字)