DePace N L, Iskandrian A S, Hakki A H, Kane S A, Segal B L
J Am Coll Cardiol. 1983 Apr;1(4):1002-10. doi: 10.1016/s0735-1097(83)80101-6.
To determine the relation between left ventricular performance during exercise and the extent of coronary artery disease, the results of exercise radionuclide ventriculography were analyzed in 65 patients who also underwent cardiac catheterization. A scoring system was used to quantitate the extent of coronary artery disease. This system takes into account the number and site of stenoses of the major coronary vessels and their secondary branches. The conventional method of interpreting the coronary angiograms indicated that 26 patients had significant coronary artery disease (defined as 70% or more narrowing of luminal diameter) of one vessel, 21 had multivessel disease and 18 had no significant coronary artery disease. Although the exercise left ventricular ejection fraction was significantly higher in patients with no coronary artery disease than in patients with one or multivessel disease (probability [p] less than 0.001), there was considerable overlap among the three groups. With the scoring system, a good correlation was found between the coronary artery disease score and the exercise left ventricular ejection fraction (r = -0.70; p less than 0.001). If the exercise heart rate was 130 beats/min or greater or the age of the patient was 50 years or less, an even better correlation was found (r = -0.73 and r = -0.82, respectively). The exercise ejection fraction (but not the change in ejection fraction, end-diastolic volume and end-systolic volume from rest to exercise) correlated with the extent of coronary artery disease. The exercise ejection fraction is the most important exercise variable that correlates with the extent of coronary artery disease when the latter is assessed quantitatively by a scoring system rather than the conventional method of reporting coronary angiograms. Young age and greater exercise heart rate strengthened the correlation. The change in ejection fraction from rest to exercise is useful in the diagnosis of coronary artery disease, but it was the absolute level of exercise ejection fraction that predicted the extent of disease.
为了确定运动期间左心室功能与冠状动脉疾病程度之间的关系，我们分析了65例同时接受心脏导管检查的患者的运动放射性核素心室造影结果。采用一种评分系统对冠状动脉疾病的程度进行量化。该系统考虑了主要冠状动脉及其分支狭窄的数量和部位。传统的冠状动脉造影解读方法显示，26例患者有单支血管的显著冠状动脉疾病（定义为管腔直径狭窄70%或更多），21例有多支血管疾病，18例无显著冠状动脉疾病。虽然无冠状动脉疾病患者的运动左心室射血分数显著高于单支或多支血管疾病患者（概率[p]小于0.001），但三组之间有相当大的重叠。使用评分系统发现，冠状动脉疾病评分与运动左心室射血分数之间存在良好的相关性（r = -0.70；p小于0.001）。如果运动心率为130次/分钟或更高或患者年龄为50岁或更小，则相关性更好（分别为r = -0.73和r = -0.82）。运动射血分数（而非静息到运动时射血分数、舒张末期容积和收缩末期容积的变化）与冠状动脉疾病程度相关。当通过评分系统而非传统的冠状动脉造影报告方法对冠状动脉疾病程度进行定量评估时，运动射血分数是与冠状动脉疾病程度相关的最重要运动变量。年轻和更高的运动心率增强了这种相关性。静息到运动时射血分数的变化对冠状动脉疾病的诊断有用，但预测疾病程度的是运动射血分数的绝对水平。
