Chierchia S, Brunelli C, Simonetti I, Lazzari M, Maseri A
Circulation. 1980 Apr;61(4):759-68. doi: 10.1161/01.cir.61.4.759.
To investigate the events that lead to acute myocardial ischemia we monitored continuously the ECG, the left ventricular (four patients) or aortic (two patients) pressure and the great cardiac vein oxygen saturation (CSO2S) by a fiberoptic catheter in six patients with frequent anginal attacks at rest. We recorded 137 transient ischemic episodes (10 with chest pain) characterized by ST-segment elevation in 28 episodes, depression in three episodes and by pseudonormalization of previously inverted or flat T waves in 106 episodes. The onset of electrocardiographic and hemodynamic changes was preceded by a large drop in CSO2S in all 135 episodes with ST-T changes in the anterior leads but not in two episodes with ST elevation on inferior leads. The fall in CSO2S, consistently followed by signs of left ventricular function impairment and never preceded by any detectable increase in the hemodynamic determinants of myocardial oxygen consumption, probably reflects a reduction in regional perfusion. Thus, a reduction in coronary flow may cause transient ischemia in patients with angina at rest. These episodes may be associated with variable, often minor electrocardiographic changes and occasionally with anginal pain.
为了研究导致急性心肌缺血的事件，我们对6例静息时频繁发作心绞痛的患者，通过光纤导管连续监测心电图、左心室压力（4例患者）或主动脉压力（2例患者）以及心大静脉血氧饱和度（CSO2S）。我们记录了137次短暂性缺血发作（其中10次伴有胸痛），其特征为：28次发作表现为ST段抬高，3次发作表现为ST段压低，106次发作表现为先前倒置或平坦的T波假性正常化。在所有135次前壁导联出现ST-T改变的发作中，心电图和血流动力学改变的发作之前均出现CSO2S大幅下降，但在下壁导联出现ST段抬高的2次发作中未出现这种情况。CSO2S下降，随后始终出现左心室功能受损的迹象，且心肌耗氧量的血流动力学决定因素从未出现任何可检测到的增加，这可能反映了局部灌注减少。因此，冠状动脉血流减少可能导致静息性心绞痛患者出现短暂性缺血。这些发作可能伴有多变的、通常轻微的心电图改变，偶尔伴有心绞痛。
