运动期间左心室射血分数的变化率在预测具有功能意义的冠状动脉疾病方面优于峰值射血分数。

Rate of change of left ventricular ejection fraction during exercise is superior to the peak ejection fraction for predicting functionally significant coronary artery disease.

作者信息

Sridhara B S, Bhattacharya S, Liu X J, Broadhurst P, Lahiri A

机构信息

Department of Cardiology, Northwick Park Hospital, Harrow.

出版信息

Br Heart J. 1993 Dec;70(6):507-12. doi: 10.1136/hrt.70.6.507.

DOI:10.1136/hrt.70.6.507

PMID:8280514

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC1025380/

Abstract

OBJECTIVE

To detect and characterise rapid temporal changes in the left ventricular response to exercise in patients with ischaemic heart disease and to relate these changes to the functional severity of coronary artery disease.

BACKGROUND

The gamma camera does not allow the detection of rapid changes in cardiac function during exercise radionuclide ventriculography, the monitoring of which may improve the assessment of patients with ischaemic heart disease.

METHODS

A miniature nuclear probe (Cardioscint) was used to monitor continuously left ventricular function during exercise in 31 patients who had coronary angiography for suspected coronary artery disease. A coronary angiographic jeopardy score was calculated for each patient.

RESULTS

The coronary jeopardy score ranged from 0 to 12 (median 4). Ejection fraction fell significantly during exercise from 46% to 34%. Patients were divided into two groups based on the response of their ejection fraction to exercise. In 14 patients (group I), the peak change in ejection fraction coincided with the end of exercise, whereas in the other 17 patients (group II) the peak change in ejection fraction occurred before the end of exercise, resulting in a brief plateau. The peak change in ejection fraction and the time to its occurrence were independent predictors of coronary jeopardy (r = -0.59, p < 0.001 for peak change and r = -0.69, p < 0.001 for time to that change). The rate of change in ejection fraction was the strongest predictor of coronary jeopardy (r = -0.81, p < 0.001). In group I the peak change in ejection fraction was a poor predictor severity of coronary disease (r = -0.28, NS), whereas the time to peak and the rate of change in ejection fraction were good predictors (r = -0.65 and r = -0.73, p < 0.01). In group II the peak, the time to the peak, and the rate of change in ejection fraction were good predictors of coronary jeopardy (r = -0.75, r = -0.61, and r = -0.83, p < 0.01).

CONCLUSION

The rate of change of ejection fraction during exercise can be assessed by continuous monitoring of left ventricular function with the nuclear probe, and is the best predictor of functionally significant coronary artery disease.

摘要

目的

检测并描述缺血性心脏病患者运动时左心室反应的快速时间变化，并将这些变化与冠状动脉疾病的功能严重程度相关联。

背景

γ相机在运动放射性核素心室造影期间无法检测心脏功能的快速变化，而对其进行监测可能会改善对缺血性心脏病患者的评估。

方法

使用微型核探头（Cardioscint）对31例因疑似冠状动脉疾病而接受冠状动脉造影的患者在运动期间连续监测左心室功能。为每位患者计算冠状动脉造影危险评分。

结果

冠状动脉危险评分范围为0至12（中位数为4）。运动期间射血分数从46%显著下降至34%。根据射血分数对运动的反应将患者分为两组。在14例患者（I组）中，射血分数的峰值变化与运动结束同时出现，而在其他17例患者（II组）中，射血分数的峰值变化在运动结束前出现，导致短暂平台期。射血分数的峰值变化及其出现时间是冠状动脉危险的独立预测因素（峰值变化：r = -0.59，p < 0.001；变化时间：r = -0.69，p < 0.001）。射血分数的变化率是冠状动脉危险的最强预测因素（r = -0.81，p < 0.001）。在I组中，射血分数的峰值变化对冠状动脉疾病严重程度的预测较差（r = -0.28，无显著性差异），而峰值时间和射血分数变化率是良好的预测因素（r = -0.65和r = -0.73，p < 0.01）。在II组中，射血分数的峰值、峰值时间和变化率是冠状动脉危险的良好预测因素（r = -0.75，r = -0.61，和r = -0.83，p < 0.01）。