Osbakken M D, Boucher C A, Okada R D, Bingham J B, Strauss H W, Pohost G M
Am J Cardiol. 1983 Jan 1;51(1):28-35. doi: 10.1016/s0002-9149(83)80007-1.
Left ventricular function was evaluated with rest and supine bicycle exercise-multigated blood pool scans in 53 patients who had previously undergone coronary angiography for evaluation of a chest pain syndrome. There were 21 normal patients (less than 25% stenosis in any coronary artery, left ventricular end-diastolic pressure less than or equal to 12 mm Hg, and normal left ventriculography) and 32 patients with coronary artery disease (CAD) (greater than 50% narrowing in 1 or more major coronary arteries). Thirty-two (60%) were receiving propranolol at the time of the study. The normal patient group had a significant increase in mean ejection fraction (EF) during exercise (+0.08 +/- 0.09), while the CAD group had no increase (0 +/- 0.11; p less than 0.05). Mean end-systolic volume decreased significantly in the normal group (-5 +/- 8 ml/m2) but demonstrated no significant change in the CAD group (1 +/- 12 ml/m2; p less than 0.05 compared with normal patients). There was no significant change in mean end-diastolic volume in either group. Mean ejection rate, mean peak systolic pressure/end-systolic volume ratio, and mean pulmonary blood volume ratio also differed in the normal versus CAD patients. Despite mean differences, there was considerable overlap in both groups of individual EF responses: 8 of 21 (38%) of the normal group did not have an increase in EF of 0.05 with exercise, while 15 of 32 (47%) of the CAD group did have an increase in EF of 0.05 with exercise. However, the addition of peak systolic pressure/end-systolic volume ratio and pulmonary blood volume (exercise/rest) ratio improved the sensitivity for detecting CAD from 53 to 84% without adversely affecting specificity. Thus, there is a wide spectrum of left ventricular EF responses to supine exercise. In our patient population, EF alone was an insensitive and nonspecific marker of CAD. The addition of other parameters of global left ventricular function, which may be generated using radionuclide angiography, helps distinguish patients with CAD from normal subjects.
对53例曾因胸痛综合征接受冠状动脉造影评估的患者，采用静息和仰卧位踏车运动多门控心血池扫描评估左心室功能。其中21例为正常患者（任何冠状动脉狭窄均小于25%，左心室舒张末期压力小于或等于12 mmHg，左心室造影正常），32例为冠状动脉疾病（CAD）患者（1支或多支主要冠状动脉狭窄大于50%）。32例（60%）患者在研究时正在服用普萘洛尔。正常患者组运动期间平均射血分数（EF）显著增加（+0.08±0.09），而CAD组无增加（0±0.11；p<0.05）。正常组平均收缩末期容积显著下降（-5±8 ml/m²），但CAD组无显著变化（1±12 ml/m²；与正常患者相比p<0.05）。两组的平均舒张末期容积均无显著变化。正常患者与CAD患者的平均射血速率、平均收缩压峰值/收缩末期容积比值以及平均肺血容积比值也存在差异。尽管存在均值差异，但两组个体EF反应有相当大的重叠：正常组21例中有8例（38%）运动时EF增加未达0.05，而CAD组32例中有15例（47%）运动时EF增加达0.05。然而，增加收缩压峰值/收缩末期容积比值和肺血容积（运动/静息）比值后，检测CAD的敏感性从53%提高到84%，且未对特异性产生不利影响。因此，仰卧位运动时左心室EF反应范围很广。在我们的患者群体中，单独的EF是CAD不敏感且非特异性的标志物。添加其他可通过放射性核素血管造影生成的左心室整体功能参数，有助于将CAD患者与正常受试者区分开来。
