Trevethan S, Pianzola E, Sánchez Torres G, Velásquez J R, Chávez B, Diez M
Arch Inst Cardiol Mex. 1981 Sep-Oct;51(5):415-22.
The assessment of atrial pacing (AP), in relation to the electrocardiographic treadmill test (ETT), was carried out in 22 patients with angina pectoris in whom the importance of the adrenergic system was also evaluated. Coronary cineangiography, left ventricular angiography and plasmatic catecholamine determinations were carried out before and after ETT and transvenous AP. All patients with coronary artery obstruction of more than 80% had positive ETT (X2 = 5.2) and 61.5% had positive AP tests (X2 = 5.2) and 61.5% had positive AP tests (X2 = 3.16). Sixty six of those patients without angiographic coronary obstruction had positive ETT and in 55.6% the AP test was also positive. The increase in systolic blood pressure was found to correlate with the increase in plasmatic catecholamine concentrations during ETT but not with AP (p less than 0.001). The electrocardiographic treadmill test has a greater specificity and sensitivity than AP and correlates with the plasmatic catecholamine concentration. Our results suggest that the myocardial ischemia produced by AP is not related to the endogenous output of catecholamines nor to the elevation of blood pressure, but rather it seems to be dependent of a greater imbalance between the cardiac debit supply ratio of oxygen induced exclusively by an increase in heart rate.
对22例心绞痛患者进行了心房起搏（AP）评估，并与心电图平板运动试验（ETT）相关联，同时还评估了这些患者肾上腺素能系统的重要性。在ETT和经静脉AP前后进行了冠状动脉造影、左心室造影和血浆儿茶酚胺测定。所有冠状动脉阻塞超过80%的患者ETT呈阳性（X2 = 5.2），61.5%的患者AP试验呈阳性（X2 = 5.2），另有61.5%的患者AP试验呈阳性（X2 = 3.16）。66例无冠状动脉造影阻塞的患者ETT呈阳性，其中55.6%的患者AP试验也呈阳性。发现收缩压升高与ETT期间血浆儿茶酚胺浓度升高相关，但与AP无关（p小于0.001）。心电图平板运动试验比AP具有更高的特异性和敏感性，且与血浆儿茶酚胺浓度相关。我们的结果表明，AP产生的心肌缺血与儿茶酚胺的内源性输出及血压升高无关，而似乎取决于仅由心率增加引起的心脏氧供与需求比率之间更大的失衡。
