Bussmann W D, Heeger J, Kaltenbach M
Z Kardiol. 1978 Jan;67(1):28-40.
51 patients with coronary heart disease had exercise tests on a bicycle ergometer (86 +/- 32 watts). Compared to a normal control group, only 13 patients had normal contractile reserve (group 4.1). In 32 patients the increase in contractility during exercise was reduced (max dP/dt below 3200 mm Hg/s, group 4.2). Patients with reduced contractile reserve were graded according to the height of left ventricular enddiastolic pressure during exercise: In patients with grade 1, enddiastolic pressure was normal. In patients with grade 2, enddiastolic pressure increased between + 4 and + 15 mm Hg and in the patients with grade 3a a above + 15 mm Hg. Contractile and relaxation reserve decreased along with a rise in enddiastolic pressure and an increase in the complaints of the patients. Severe chest pain led to termination of exercise in patients of grade 3b. Enddiastolic pressure increased above + 15 mm Hg. During ischemia, peak-measured velocity of contractile elements (dP/dt/P) and the maximal rate of left ventricular pressure fall (min dP/dt) decreased. In conclusion, with increasing chest pain a decrease of contractile reserve was observed. Left ventricular enddiastolic pressure rose excessively. This has to be taken as a sign of myocardial failure due to ischemic dyskinesia and impeded relaxation.
51例冠心病患者在自行车测力计上进行运动试验（86±32瓦）。与正常对照组相比，只有13例患者具有正常的收缩储备（第4.1组）。32例患者运动期间收缩力增加减少（最大dp/dt低于3200mmHg/s，第4.2组）。收缩储备降低的患者根据运动期间左心室舒张末期压力的高度进行分级：1级患者舒张末期压力正常。2级患者舒张末期压力升高4至15mmHg，3a级患者高于15mmHg。收缩和舒张储备随着舒张末期压力的升高和患者主诉的增加而降低。严重胸痛导致3b级患者运动终止。舒张末期压力升高超过15mmHg。缺血期间，收缩成分的峰值测量速度（dp/dt/P）和左心室压力下降的最大速率（最小dp/dt）降低。总之，随着胸痛加剧，观察到收缩储备降低。左心室舒张末期压力过度升高。这必须被视为缺血性运动障碍和舒张受阻导致心肌衰竭的迹象。
