Neuhaus K L, Tebbe U, Kreuzer H
Z Kardiol. 1979 Dec;68(12):791-801.
Left ventricular diastolic pressure-volume relations (PVR) were analysed from biplane ventriculograms and simultaneous pressure measurements in 33 patients at rest (R) and during ergometer exercise (E) (8 normals [N], 8 patients with coronary artery disease [CAD], 8 patients with congestive cardiomyopathy [COCM], 5 patients with aortic insufficiency [AI] and 5 patients with pressure overload (4 with aortic stenosis [A-St.] and 1 coarctation of the aorta). In N and AI diastolic PVR was essentially unchanged with E, the time constant of isovolumic relaxation (T) decreased significantly (N: delta T = -24.4 +/- 11.6%, p less than 0.001; AI: delta T = -27.3 +/- 6.8%, p less than 0.005). In CAD diastolic PVR was shifted upwards in all cases with angina pectoris during E (7/8), minimal rate of left ventricular pressure change (dp/dtmin) and T did not change significantly. In COCM diastolic PVR was shifted upwards in 4 cases, while dp/dtmin increased significantly (R = -1107 +/- 327, E = -1508 +/- 626 mm Hg-s-1, p less than 0.05), T on the average was unchanged (R = 53 +/- 10.5, E = 51 +/- 14.2 msec). In A-St. in 3 of 4 cases diastolic PVR was significantly shifted upwards with E, dp/dtmin increased (R = -1633 +/- 93, E = -2093 +/- 170 mm Hg-s-1, p less than 0.001), T in contrast to N and AI was prolonged (R = 33.8 +/- 4, E = 39.9 +/- 1.9 msec).
In N and AI diastolic ventricular function is not altered with exercise. In COCM and especially in A-St., however, there are similar alterations like in CAD with angina pectoris. Changes in T indicate that shifts of the PVR with exercise in non-ischemic heart disease are related to a disturbed ventricular relaxation.
通过双平面心室造影和同步压力测量，分析了33例患者静息状态（R）和测力计运动状态（E）下的左心室舒张压力-容积关系（PVR）（8例正常人[N]，8例冠状动脉疾病[CAD]患者，8例充血性心肌病[COCM]患者，5例主动脉瓣关闭不全[AI]患者，以及5例压力超负荷患者（4例主动脉瓣狭窄[A-St.]和1例主动脉缩窄）。在正常人和主动脉瓣关闭不全患者中，舒张期PVR在运动时基本不变，等容舒张时间常数（T）显著降低（正常人：ΔT = -24.4±11.6%，p<0.001；主动脉瓣关闭不全：ΔT = -27.3±6.8%，p<0.005）。在冠状动脉疾病患者中，所有心绞痛发作的病例在运动时舒张期PVR均向上移位（7/8），左心室压力变化最小速率（dp/dtmin）和T无显著变化。在充血性心肌病患者中，4例舒张期PVR向上移位，而dp/dtmin显著增加（静息时=-1107±327，运动时=-1508±626 mmHg-s-1，p<0.05），T平均无变化（静息时=53±10.5，运动时=51±14.2毫秒）。在主动脉瓣狭窄患者中，4例中有3例舒张期PVR在运动时显著向上移位，dp/dtmin增加（静息时=-1633±93，运动时=-2093±170 mmHg-s-1，p<0.001），与正常人和主动脉瓣关闭不全患者相比，T延长（静息时=33.8±4，运动时=39.9±1.9毫秒）。
在正常人和主动脉瓣关闭不全患者中，舒张期心室功能不会因运动而改变。然而，在充血性心肌病尤其是主动脉瓣狭窄患者中，存在与心绞痛发作时冠状动脉疾病患者类似的改变。T的变化表明，非缺血性心脏病运动时PVR的移位与心室舒张障碍有关。
