Klepzig H, Scherer D, Kober G, Maul F D, Kanemoto N, Standke R, Hör G, Kaltenbach M
Herz. 1981 Aug;6(4):252-8.
To assess the results of transluminal coronary angioplasty (TCA), 42 patients (mean age 50 years) with for coronary artery disease were investigated at rest and during exercise with the ECG (n = 40), thallium-201 myocardial scintigraphy (n = 23) and equilibrium-radionuclide ventriculography (n = 32). Each method of stress testing was quantified: the exercise ECG by means of an ischemia score, incremented with increasing ST-segment depression and decremented as a function of duration of exercise and workload in watts; thallium-201 scintigraphy by means of an index for minimal to maximal perfusion region (vitality index) and redistribution factors; equilibrium-radionuclide ventriculography by means of global ejection fraction and maximum systolic volume change with respect to the end-diastolic volume. The patients were divided into three groups: 30 had successful TCA defined as demonstrating at least a 20% reduction in the stenosis; six underwent aortocoronary bypass operation (nine grafts; complete revascularization in four patients); and in six patients TCA was unsuccessful. TCA was successful in 24 LAD stenoses, 5 RCA stenoses, and in one proximal anastomosis of an aortocoronary bypass graft. Dilatation could not be achieved in three LAD stenoses and three stenoses of the RCA. In those in whom it was successful, TCA yielded an average reduction of coronary artery stenosis from 84 to 43%. Both TCA and bypass operation (OP) led to comparable degrees of functional improvement. The ischemia score decreased from 2.8 to 0.9 after TCA and from 1.6 to 0 after OP. The vitality index increased from 67 to 77% and from 74 to 81% after TCA and OP respectively while the corresponding redistribution factors decreased (TCA: at 1 hour from 5 to 1% and at 3.5 hours from 11 to 4%; OP: at 1 hour from 2.2 to 1.4% and at 3.5 hours from 7.6 to 4.1%. The global ejection fractions at rest improved from 46 to 52% and from 38 to 45% and during exercise from 42 to 50% and from 36 to 43% after TCA and OP respectively. The maximum--dV/dt/EDV increased at rest (TCA: from 2.7 to 3.5 per second; OP: from 2.1 to 3.8 per second) and during exercise (TCA: from 3.1 to 4.0 per second; OP: from 2.6 to 3.3 per second). In the group with unsuccessful TCA, no significant differences in the latter parameters were observed. Ten of the 30 patients who had undergone successful dilatation were reinvestigated after three months. Maintenance of good functional results could be documented in eight while deterioration was seen in two patients, one with a significant restenosis and one who developed a new narrowing distal to the successfully dilated stenosis. Thus, the results show that in selected cases, TCA can render improved ventricular function and perfusion comparable to that of aortocoronary artery bypass surgery.
为评估经皮腔内冠状动脉成形术（TCA）的效果，对42例（平均年龄50岁）冠心病患者在静息状态及运动期间进行了研究，采用心电图（n = 40）、铊 - 201心肌闪烁显像（n = 23）和平衡放射性核素心室造影（n = 32）。每种负荷试验方法均进行了量化：运动心电图通过缺血评分来量化，随着ST段压低程度增加而升高，随着运动持续时间和以瓦特为单位的工作量而降低；铊 - 201闪烁显像通过最小至最大灌注区域指数（活力指数）和再分布因子来量化；平衡放射性核素心室造影通过整体射血分数以及相对于舒张末期容积的最大收缩期容积变化来量化。患者被分为三组：30例TCA成功，定义为狭窄至少降低20%；6例行主动脉冠状动脉旁路移植术（9支移植物；4例患者实现完全血运重建）；6例患者TCA未成功。TCA成功应用于24处左前降支狭窄、5处右冠状动脉狭窄以及1处主动脉冠状动脉旁路移植术的近端吻合口。3处左前降支狭窄和3处右冠状动脉狭窄未能成功扩张。在成功的病例中，TCA使冠状动脉狭窄平均从84%降至43%。TCA和旁路手术（OP）均带来了相当程度的功能改善。TCA后缺血评分从2.8降至0.9，OP后从1.6降至0。活力指数在TCA后从67%升至77%，OP后从74%升至81%，而相应的再分布因子降低（TCA：1小时时从5%降至1%，3.5小时时从11%降至4%；OP：1小时时从2.2%降至1.4%，3.5小时时从7.6%降至4.1%）。静息时整体射血分数在TCA后从46%升至52%，OP后从38%升至45%；运动时在TCA后从42%升至50%，OP后从36%升至43%。最大 - dV/dt/EDV在静息时升高（TCA：从每秒2.7升至3.5；OP：从每秒2.1升至3.8），运动时也升高（TCA：从每秒3.1升至4.0；OP：从每秒2.6升至3.3）。在TCA未成功的组中，未观察到上述参数有显著差异。30例成功扩张的患者中有10例在三个月后再次接受检查。8例患者的良好功能结果得以维持，2例患者出现恶化，1例有明显的再狭窄，1例在成功扩张的狭窄远端出现新的狭窄。因此，结果表明，在选定的病例中，TCA可使心室功能和灌注得到改善，与主动脉冠状动脉旁路手术相当。
