Sasayama S, Nonogi H, Fujita M, Sakurai T, Wakabayashi A, Kawai C, Eiho S, Kuwahara M
J Am Coll Cardiol. 1984 May;3(5):1187-96. doi: 10.1016/s0735-1097(84)80176-x.
Biplane cineventriculography was performed at rest and after sublingual nitroglycerin in 13 patients with coronary artery disease. In six patients (responders), there was a significant increase in ejection fraction [40 +/- 5 to 52 +/- 4% (p less than 0.001)], while in the other seven (nonresponders), there was no alteration in ejection fraction. To evaluate the extent of regional myocardial response to nitroglycerin, the contractile pattern of the regional myocardium over the entire ventricular surface was analyzed using a computer-generated three-dimensional model. The spatial coordinates that define the elliptic ventricular surface on a given horizontal plane cross section of the chamber were determined by four counter values in the two orthogonal silhouettes. Then, 32 points at equal angles around the center of gravity of the end-diastolic cavity were generated to form the border image. Repetition of this process for 16 successive cross sections allowed for reconstruction of the ventricular surface by the sequence of 32 X 16 (512) points. The regional wall motion was expressed as the percent change of the radial length, drawn from the center of gravity to each surface point. There was significant heterogeneity in regional response to nitroglycerin. In the responders, the normally contracting area was significantly increased (from 16.5 +/- 16.0 to 36.2 +/- 14.9% of the total surface area, p less than 0.001), largely mediated by the greater improvement in segmental shortening of each graded contractile pattern relative to its deterioration. In the nonresponders, a lessening of the severe dysfunction of the given area was associated with significant deterioration of segmental shortening of the other normally contracting area (49.1 +/- 19.7% of the area with a contractile pattern of grade 5 had deteriorated, p less than 0.05). Thus, the ratio of the area with respective graded segmental shortening was virtually unchanged. These differences in response of the ischemic ventricle to nitroglycerin appeared to be related to the development of adequate coronary collateral vessels as well as to an interaction of changes in preload and afterload.
对13例冠心病患者在静息状态下以及舌下含服硝酸甘油后进行了双平面心脏电影造影检查。6例患者（反应者）射血分数显著增加[从40±5%增至52±4%（p<0.001）]，而另外7例（无反应者）射血分数无变化。为评估局部心肌对硝酸甘油的反应程度，使用计算机生成的三维模型分析了整个心室表面局部心肌的收缩模式。通过两个正交轮廓中的四个计数器值确定在心室腔给定水平横截面上定义椭圆形心室表面的空间坐标。然后，在舒张末期腔重心周围以等角度生成32个点以形成边界图像。对16个连续横截面重复此过程，通过32×16（512）个点的序列重建心室表面。局部壁运动表示为从重心到每个表面点绘制的径向长度的百分比变化。局部对硝酸甘油的反应存在显著异质性。在反应者中，正常收缩区域显著增加（从总表面积的16.5±16.0%增至36.2±14.9%，p<0.001），这主要是由于每个分级收缩模式的节段缩短相对于其恶化有更大改善所致。在无反应者中，给定区域严重功能障碍的减轻与其他正常收缩区域节段缩短的显著恶化相关（收缩模式为5级的区域中有49.1±19.7%恶化，p<0.05）。因此，具有相应分级节段缩短的区域比例实际上没有变化。缺血性心室对硝酸甘油反应的这些差异似乎与充分的冠状动脉侧支血管的形成以及前负荷和后负荷变化的相互作用有关。
