Ajisaka R
Jpn Heart J. 1983 Mar;24(2):161-74. doi: 10.1536/ihj.24.161.
Left ventricular asynergy has been shown to occur commonly in patients with coronary artery disease (CAD) and to be induced or exaggerated by exercise. The purpose of this study is to report on a method to detect asynergy and estimate its severity by M-mode echocardiographic analysis of left ventricular wall motion at rest and during supine ergometric exercise. Sixteen patients with CAD underwent graded supine ergometric exercise until anginal pain occurred or apparent ischemic changes were noted on ECG. This study was done using the following criteria: 1) Asynergy at rest was defined as occurring when the amplitudes of the interventricular septum and/or the posterior left ventricular wall were below normal values at rest. 2) Asynergy during exercise was defined as occurring when one or both of the two amplitudes were more than 2 mm below the values at rest (severe) or were unchanged in spite of sufficient exercise load (mild). The results were as follows: 1) In the normal subjects, the septal and posterior wall amplitudes increased during exercise (ranging from 7 mm to 9 mm for the septum, and from 13 mm to 16 for the posterior wall). In patients with CAD, asynergy at rest was demonstrated in only 3 cases (19%), whereas septal and/or posterior wall asynergy during exercise was noted in 75% of cases. 2) The location of exercise-induced asynergy detected by echocardiography showed a good correlation with that of coronary artery lesions (greater than or equal to 75% stenosis) recognized by angiography. 3) Significant differences were observed between changes in left ventricular dimensions in patients with CAD and those of normals during exercise. In the normal subjects, left ventricular end-systolic dimension (ESD) decreased without significant change in end-diastolic dimension (EDD) during exercise. On the other hand, both ESD and EDD increased during exercise in patients with CAD. Although echocardiographic analysis of left ventricular wall motion during exercise has some limitations, this study suggests that asynergy induced or exaggerated by ergometric exercise can be successfully detected by M-mode echocardiography.
左心室协同失调已被证明在冠心病（CAD）患者中普遍存在，并可由运动诱发或加重。本研究的目的是报告一种通过M型超声心动图分析静息和仰卧位运动负荷试验时左心室壁运动来检测协同失调并评估其严重程度的方法。16例CAD患者进行了分级仰卧位运动负荷试验，直至出现心绞痛或心电图上出现明显缺血改变。本研究采用以下标准：1）静息时的协同失调定义为室间隔和/或左心室后壁的幅度低于静息时的正常值。2）运动时的协同失调定义为两个幅度中的一个或两个比静息时的值低2mm以上（严重）或尽管运动负荷充足但幅度未改变（轻度）。结果如下：1）在正常受试者中，运动时室间隔和后壁的幅度增加（室间隔从7mm到9mm，后壁从13mm到16mm）。在CAD患者中，仅3例（19%）出现静息时的协同失调，而75%的病例在运动时出现室间隔和/或后壁协同失调。2）超声心动图检测到的运动诱发协同失调的部位与血管造影所识别的冠状动脉病变（狭窄大于或等于75%）的部位具有良好的相关性。3）CAD患者与正常受试者在运动时左心室尺寸变化之间存在显著差异。在正常受试者中，运动时左心室收缩末期内径（ESD）减小，舒张末期内径（EDD）无显著变化。另一方面，CAD患者运动时ESD和EDD均增加。尽管运动时左心室壁运动的超声心动图分析有一些局限性，但本研究表明，通过M型超声心动图可以成功检测到运动负荷试验诱发或加重的协同失调。
