在存在或不存在冠状动脉疾病的情况下，动态运动期间左心室肥厚对左心室功能的影响。

Influence of left ventricular hypertrophy on left ventricular function during dynamic exercise in the presence or absence of coronary artery disease.

作者信息

Sobue T, Yokota M, Iwase M, Ishihara H

机构信息

First Department of Internal Medicine, Nagoya University Hospital, Japan.

出版信息

J Am Coll Cardiol. 1995 Jan;25(1):91-8. doi: 10.1016/0735-1097(94)00347-s.

DOI:10.1016/0735-1097(94)00347-s

PMID:7798532

Abstract

OBJECTIVES

We investigated the influence of left ventricular hypertrophy in the presence or absence of coronary artery disease on hemodynamic characteristics during exercise in subjects without previous myocardial infarction.

BACKGROUND

Left ventricular hypertrophy has been found to increase the vulnerability of the myocardium to the development of ischemia. However, the independent influences of left ventricular hypertrophy and coronary artery disease have not been assessed in humans.

METHODS

Symptom-limited supine leg exercise tests were performed by 78 patients. They were classified into the following subgroups: no coronary artery disease or left ventricular hypertrophy (group I, n = 30), left ventricular hypertrophy only (group II, n = 12), coronary artery disease only (group III, n = 20) and both left ventricular hypertrophy and coronary artery disease (group IV, n = 16). Mean left ventricular mass index was 105, 158, 109 and 159 g/m2 in groups I to IV, respectively.

RESULTS

Pulmonary artery wedge pressure increased from 6 +/- 3 (mean +/- SD) mm Hg at rest to 10 +/- 5 mm Hg at peak exercise in group I, from 8 +/- 2 to 18 +/- 8 mm Hg in group II (p < 0.05 vs. group I), from 6 +/- 3 to 23 +/- 6 mm Hg in group III (p < 0.01 vs. group I) and from 8 +/- 4 to 30 +/- 7 mm Hg in group IV (p < 0.01 vs. group I; p < 0.01 vs. group II; p < 0.05 vs. group III). Multiple regression analysis showed that the number of diseased coronary vessels and left ventricular mass index were independent predictors of peak pulmonary artery wedge pressure (F = 59.2 and 19.1, respectively; multiple correlation coefficient r = 0.74, p < 0.0001).

CONCLUSIONS

Left ventricular hypertrophy and coronary artery disease independently increased left ventricular filling pressure during supine leg exercise. Severe left ventricular dysfunction was induced by exercise when both conditions were present.

摘要

目的

我们研究了有无冠状动脉疾病情况下左心室肥厚对无既往心肌梗死受试者运动期间血流动力学特征的影响。

背景

已发现左心室肥厚会增加心肌发生缺血的易感性。然而，左心室肥厚和冠状动脉疾病的独立影响尚未在人体中得到评估。

方法

对78例患者进行了症状限制的仰卧腿部运动试验。他们被分为以下亚组：无冠状动脉疾病或左心室肥厚（I组，n = 30）、仅左心室肥厚（II组，n = 12）、仅冠状动脉疾病（III组，n = 20）以及左心室肥厚和冠状动脉疾病均有（IV组，n = 16）。I至IV组的平均左心室质量指数分别为105、158、109和159 g/m²。

结果

I组肺动脉楔压从静息时的6±3（均值±标准差）mmHg增加至运动峰值时的10±5 mmHg，II组从8±2 mmHg增加至18±8 mmHg（与I组相比，p < 0.05），III组从6±3 mmHg增加至23±6 mmHg（与I组相比，p < 0.01），IV组从8±4 mmHg增加至30±7 mmHg（与I组相比，p < 0.01；与II组相比，p < 0.01；与III组相比，p < 0.05）。多元回归分析表明，病变冠状动脉血管数量和左心室质量指数是肺动脉楔压峰值的独立预测因素（F分别为59.2和19.1；多元相关系数r = 0.74，p < 0.0001）。