Tubau J, Slutsky R A, Gerber K H, Peterson K, Ashburn W, Higgins C B, LeWinter M
Am Heart J. 1983 Jun;105(6):940-5. doi: 10.1016/0002-8703(83)90394-0.
Little data exist about the relationship between changes in cardiac end-diastolic pressure and changes in pulmonary blood volume. To assess this relationship, we studied 11 patients with coronary heart disease during atrial pacing in an attempt to produce multiple pressure-volume points. During catheterization, we obtained Millar pressure recordings of end-diastolic pressure along with equilibrium radionuclide angiograms. Cardiac output, ejection fraction, and pulmonary blood volume were obtained by means of recently validated radionuclide techniques. During pacing, substantial changes in pulmonary blood volume occurred only with marked increase in end-diastolic pressure volume (greater than or equal to 15 mm Hg) and rarely exceeded 15% of control pulmonary blood volume. Cardiac output did not change, while ejection fraction declined during pacing. There was a fair correlation between the absolute change in pulmonary activity (or pulmonary blood volume) or the percentage of change in pulmonary activity over the control value with end-diastolic pressure when all the data points were evaluated (n = 74, r greater than 0.70). However, the scatter in the data precluded making accurate estimates of pressure changes from changes in radionuclide volume changes. We conclude that large changes in cardiac filling pressure must occur during atrial pacing, where cardiac output does not change, before visible pulmonary blood volume changes occur. This may limit the extrapolation of presumed pressure changes from known pulmonary blood volume when changes are small.
关于心脏舒张末期压力变化与肺血容量变化之间的关系，现有数据很少。为了评估这种关系，我们研究了11例冠心病患者在心房起搏期间的情况，试图产生多个压力-容量点。在导管插入过程中，我们获得了舒张末期压力的米勒压力记录以及平衡放射性核素血管造影。心输出量、射血分数和肺血容量通过最近验证的放射性核素技术获得。在起搏期间，仅在舒张末期压力容量显著增加（大于或等于15毫米汞柱）时肺血容量才会发生实质性变化，且很少超过对照肺血容量的15%。起搏期间心输出量未改变，而射血分数下降。当评估所有数据点时（n = 74，r大于0.70），肺活动的绝对变化（或肺血容量）或肺活动相对于对照值的变化百分比与舒张末期压力之间存在良好的相关性。然而，数据的离散性使得无法根据放射性核素体积变化准确估计压力变化。我们得出结论，在心房起搏期间，当心输出量不变时，在可见的肺血容量变化发生之前，心脏充盈压力必须发生大幅变化。当变化很小时，这可能会限制从已知肺血容量推断假定压力变化的能力。
