Lewis R P, Boudoulas H, Welch T G, Forester W F
Am J Cardiol. 1976 Apr;37(5):787-96. doi: 10.1016/0002-9149(76)90376-3.
This review summarizes current knowledge concerning the value of systolic time intervals in coronary artery disease. Although the usual pattern of prolongation of the preejection period (PEP) and shortening of the left ventricular ejection time (LVET) characteristic of left ventricular failure is seen in acute myocardial infarction, the systolic time intervals (as well as all other measures) are profoundly influenced by adrenergic hyperactivity characteristics of this disorder. Adrenergic stimulation normally shortens both the PEP and LVET indexes and decreases the PEP/LVET ratio. The degree of shortening of electromechanical systole (QS2) is directed related to the excessive adrenergic tone. Patients with the greatest systolic time interval abnormalities have a poorer prognosis, a greater incidence of congestive heart failure and more abnormalities of directly measured indexes of left ventricular performance. The systolic time intervals are useful for assessing left ventricular performance in chronic coronary artery disease as well. In chronic coronary artery disease the PEP/LVET ratio and angiographically determined left ventricular ejection fraction are closely correlated ( r = -0.76), but the level of this correlation is less than that in other forms of left ventricular disease. The left ventricular ejection time index is prolonged after exercise in patients with angina pectoris when compared with findings in normal subjects. Failure of the ischemic ventricle to respond to adrenergic stimulation is the most likely mechanism. Addition of the postexercise left ventricular ejection time to standard treadmill stress testing identifies a significant number of patients (23 percent) who would have had false negative results by electrocardiographic criteria alone. In addition, this index provides confirmatory evidence in those with apparently positive electrocardiographic test data. The systolic time intervals have been useful in assessing both medical and surgical therapy in coronary artery disease. The test can be performed repeatedly and provides a measure of both left ventricular performance and extent of adrenergic hyperactivity. Thus, evaluation of therapy represents the most useful future application of systolic time intervals.
本综述总结了目前关于收缩期时间间期在冠状动脉疾病中价值的知识。虽然在急性心肌梗死中可见到左心室衰竭特有的射血前期（PEP）延长和左心室射血时间（LVET）缩短的常见模式，但收缩期时间间期（以及所有其他指标）受到该疾病肾上腺素能亢进特征的深刻影响。肾上腺素能刺激通常会缩短PEP和LVET指标，并降低PEP/LVET比值。机电收缩期（QS2）的缩短程度与肾上腺素能张力过高直接相关。收缩期时间间期异常最严重的患者预后较差，充血性心力衰竭的发生率更高，左心室功能直接测量指标的异常也更多。收缩期时间间期在评估慢性冠状动脉疾病中的左心室功能方面也很有用。在慢性冠状动脉疾病中，PEP/LVET比值与血管造影确定的左心室射血分数密切相关（r = -0.76），但这种相关性的程度低于其他形式的左心室疾病。与正常受试者相比，心绞痛患者运动后左心室射血时间指数延长。缺血性心室对肾上腺素能刺激无反应最可能是其机制。在标准跑步机压力测试中加入运动后左心室射血时间，可识别出大量（23%）仅根据心电图标准会得出假阴性结果的患者。此外，该指标为心电图测试数据明显阳性的患者提供了确证证据。收缩期时间间期在评估冠状动脉疾病的药物和手术治疗方面都很有用。该测试可以重复进行，并提供左心室功能和肾上腺素能亢进程度的测量。因此，评估治疗是收缩期时间间期未来最有用的应用。
