Jondeau G, Dorent R, Bors V, Dib J C, Dubourg O, Benzidia R, Gandjbakhch I, Bourdarias J P
Service de Cardiologie, Hôpital A. Paré, Boulogne, France.
J Am Coll Cardiol. 1995 Jul;26(1):129-34. doi: 10.1016/0735-1097(95)00117-i.
This study sought to assess the short-term effect of discontinuing latissimus dorsi muscle stimulation on left ventricular systolic and diastolic performance and exercise tolerance in patients with improved functional status by cardiomyoplasty, in whom latissimus dorsi muscle was fully conditioned.
Cardiomyoplasty has consistently improved the functional status of patients, but the short-term effect of latissimus dorsi muscle contraction has not been assessed in these patients.
Right-heart catheterization, Doppler-echocardiography and maximal exercise testing with expired gas analysis were performed in 10 patients with congestive heart failure who had undergone cardiomyoplasty at least 6 months earlier. Data were obtained when the latissimus dorsi muscle was stimulated every other systole and after stimulation was discontinued for 1 h. The power of this study to detect a 10% difference was > 80%.
After cardiomyoplasty, left ventricular ejection fraction increased from 0.22 +/- 0.08 (mean +/- SD) to 0.27 +/- 0.07 after 6 months (p < 0.02 vs. before cardiomyoplasty) and to 0.24 +/- 0.09 after 1 year; functional class went from 3.0 +/- 0.0 to 2.0 +/- 0.5 after 6 months and to 2.0 +/- 0.7 after 1 year (both p < 0.001 vs. before cardiomyoplasty). After discontinuation of latissimus dorsi muscle stimulation, cardiac index did not change (2.28 +/- 0.45 vs. 2.30 +/- 0.46 liters/min per m2). Mean systemic arterial and pulmonary capillary wedge pressures were also similar (85.2 +/- 6.0 vs. 88.4 +/- 5.6 mm Hg and 14.9 +/- 7.1 vs. 13.6 +/- 6.8 mm Hg, respectively). Doppler E/A ratio decreased from 1.04 +/- 0.33 to 0.83 +/- 0.25 (p < 0.02), suggesting that left ventricular diastolic function may have been improved by latissimus dorsi muscle stimulation. Peak oxygen consumption was unaltered (1,633 +/- 530 vs. 1,596 +/- 396 ml/min).
Alterations in left ventricular diastolic rather than systolic function may be responsible for the long-term clinical benefits of cardiomyoplasty.
本研究旨在评估对于通过背阔肌成形术功能状态已改善且背阔肌已完全适应的患者，停止背阔肌刺激对左心室收缩和舒张功能以及运动耐量的短期影响。
背阔肌成形术持续改善了患者的功能状态，但尚未对这些患者背阔肌收缩的短期影响进行评估。
对10例至少在6个月前接受过背阔肌成形术的充血性心力衰竭患者进行了右心导管检查、多普勒超声心动图检查以及带有呼出气体分析的最大运动测试。在每隔一个心动周期刺激背阔肌时以及停止刺激1小时后获取数据。本研究检测10%差异的效能>80%。
背阔肌成形术后，左心室射血分数在6个月后从0.22±0.08（均值±标准差）增至0.27±0.07（与背阔肌成形术前相比，p<0.02），1年后增至0.24±0.9；心功能分级在6个月后从3.0±0.0降至2.0±0.5，1年后降至2.0±0.7（两者与背阔肌成形术前相比，p均<0.001）。停止背阔肌刺激后，心脏指数未改变（2.28±0.45对2.30±0. m2）。平均体循环动脉压和肺毛细血管楔压也相似（分别为85.2±6.0对88.4±5.6 mmHg以及14.9±7.1对13.6±6.8 mmHg）。多普勒E/A比值从1.04±0.33降至0.83±0.25（p<0.02），提示背阔肌刺激可能改善了左心室舒张功能。峰值耗氧量未改变（1633±530对1596±396 ml/min）。
左心室舒张功能而非收缩功能的改变可能是背阔肌成形术长期临床获益的原因。
