Borer J S, Bacharach S L, Green M V, Kent K M, Henry W L, Rosing D R, Seides S F, Johnston G S, Epstein S E
Am J Cardiol. 1978 Sep;42(3):351-7. doi: 10.1016/0002-9149(78)90927-x.
In patients with aortic regurgitation,, left ventricular dysfunction at rest, which is associated with a poor long-term prognosis, often develops before severe symptoms. To determine whether evidence of left ventricular dysfunction could be detected before it appeared at rest, 43 patients with severe aortic regurgitation were studied using radionuclide cineangiography during exercise. In 30 normal subjects, left ventricular ejection fraction increased during exercise (57 +/- 1 percent [mean +/- standard error] at rest, 71 +/- 2 percent during exercise, P less than 0.001). In contrast, among 21 symptomatic patients, ejection fraction was normal at rest in 14 patients (average 47 +/- 2 percent) but normal during exercise in only one patient (average 38 +/- 2 percent, P less than 0.001). Ejection fraction was normal at rest in 21 of 22 asymptomatic patients (average 62 +/- 2 percent) but was normal during exercise in only 13 (average 57 +/- 3 percent, P less than 0.001). Thus, exericse-induced left ventricular dysfunction can precede symptoms and dysfunction at rest. Radionuclide assessment of left ventricular function during exercise may prove valuable in sequentially following the state of left ventricular function in patients before the onset of symptoms or of irreversible left ventricular failure.
在主动脉瓣反流患者中，静息时左心室功能障碍与不良的长期预后相关，且往往在出现严重症状之前就已发生。为了确定在静息时出现左心室功能障碍之前是否能检测到相关证据，对43例严重主动脉瓣反流患者在运动期间进行了放射性核素心血管造影研究。在30名正常受试者中，运动期间左心室射血分数增加（静息时为57±1%[平均值±标准误]，运动期间为71±2%，P<0.001）。相比之下，在21例有症状的患者中，14例患者静息时射血分数正常（平均47±2%），但运动期间仅1例患者射血分数正常（平均38±2%，P<0.001）。22例无症状患者中有21例静息时射血分数正常（平均62±2%），但运动期间仅13例正常（平均57±3%，P<0.001）。因此，运动诱发的左心室功能障碍可先于症状和静息时的功能障碍出现。运动期间对左心室功能进行放射性核素评估，对于在患者出现症状或不可逆左心室衰竭之前连续跟踪左心室功能状态可能具有重要价值。
