Henein M Y, Priestley K, Davarashvili T, Buller N, Gibson D G
Cardiac Department, Royal Brompton National Heart and Lung Hospital, London.
Br Heart J. 1993 Jun;69(6):501-6. doi: 10.1136/hrt.69.6.501.
To study the early effects of coronary angioplasty on resting left ventricular long axis function, reflecting that of the subendocardium.
Prospective echocardiographic and Doppler examination of patients with coronary artery disease, before and after single vessel coronary angioplasty.
A tertiary referral centre for cardiac diseases with facilities for invasive and non-invasive investigation.
23 patients with significant left coronary disease being considered for coronary angioplasty.
Before angioplasty the mean (SD) isovolumic relaxation time was longer than normal (75(19) ms v 55 (10), p < 0.001) with a significant increase in transverse dimension change before mitral valve opening, and peak rate of early diastolic thinning (8(3) v 10.4 (2.6) cm/s (p < 0.001)) was reduced. Long axis motion was frequently abnormal. The interval from the onset of the Q wave to the onset of shortening was prolonged (118 (30) ms v 90 (19) at the left site and 115 (26) ms v 81 (9) at the septal site, p < 0.001) and the onset of early diastolic rapid lengthening delayed with respect to the aortic valve closure sound (A2) by 85 (34) ms v 58 (11) at the left site and 88 (33) ms v 60 (9) at the septal site (p < 0.001). Although overall amplitude was reduced at the septal site only (1.23 (0.3) cm v 1.5 (0.4), p < 0.05), the extent (0.8 (0.2) cm v 1.04 (0.3) at the left site and 0.66 (0.2) cm v 0.9 (0.3) at the septal site, p < 0.001) and peak rate (6.2 (2) cm/s v 10 (2.5) at the left site and 5.4 (2.3) cm/s v 8.5 (2) at the septal site, p < 001) of early diastolic lengthening were both much lower than normal. The E/A ratio on transmitral Doppler was modestly reduced (1.0 (0.7) v 1.4 (0.4), p < 0.05). After angioplasty: isovolumic relaxation time shortened to 64 (18) ms (p < 0.001) and left ventricular incoordination regressed. Long axis shortening with respect to Q (98 (32) ms v 118 (30) at the left site and 94 (23) ms v 115 (26) at the septal site, p < 0.01) and that of lengthening with respect to A2 both normalised. Early diastolic peak lengthening rate increased (7.5 (2.1) cm/s v 6.2 (2) at the left site, and 6.3 (2.4) cm/s v 5.4 (2.3) at the septal site, p < 0.001). The early diastolic peak thinning rate of the posterior wall significantly increased (10 (3.5) cm/s v 8 (3), p < 0.005) as did mitral E/A ratio 1.2 (0.7) v 1.0 (0.7), p < 0.05).
Long axis motion, representing the function of longitudinally arranged subendocardial fibres, is consistently abnormal in the resting state in coronary artery disease. These systolic and diastolic abnormalities return towards normal after successful angioplasty, suggesting that they are the direct effect of coronary artery stenosis.
研究冠状动脉成形术对静息状态下左心室长轴功能（反映心内膜下功能）的早期影响。
对冠心病患者在单支血管冠状动脉成形术前和术后进行前瞻性超声心动图和多普勒检查。
一家具备侵入性和非侵入性检查设施的三级心脏病转诊中心。
23例患有严重左冠状动脉疾病且考虑进行冠状动脉成形术的患者。
成形术前，平均（标准差）等容舒张时间长于正常（75（19）毫秒对55（10）毫秒，p<0.001），二尖瓣开放前横向维度变化显著增加，舒张早期变薄峰值速率降低（8（3）对10.4（2.6）厘米/秒（p<0.001））。长轴运动常异常。从Q波起始到缩短起始的间期延长（左室部位为118（30）毫秒对90（19）毫秒，间隔部位为115（26）毫秒对81（9）毫秒，p<0.001），舒张早期快速延长起始相对于主动脉瓣关闭音（A2）延迟，左室部位为85（34）毫秒对58（11）毫秒，间隔部位为88（33）毫秒对60（9）毫秒（p<0.001）。虽然仅间隔部位的总体幅度降低（1.23（0.3）厘米对1.5（0.4）厘米，p<0.05），但舒张早期延长的程度（左室部位为0.8（0.2）厘米对1.04（0.3）厘米，间隔部位为0.66（0.2）厘米对0.9（0.3）厘米，p<0.001）和峰值速率（左室部位为6.2（2）厘米/秒对10（2.5）厘米/秒，间隔部位为5.4（2.3）厘米/秒对8.5（2）厘米/秒，p<0.001）均远低于正常。经二尖瓣多普勒测得的E/A比值略有降低（1.0（0.7）对1.4（0.4），p<0.05）。成形术后：等容舒张时间缩短至64（18）毫秒（p<0.001），左心室不协调消退。相对于Q波的长轴缩短（左室部位为98（32）毫秒对118（30）毫秒，间隔部位为94（23）毫秒对115（26）毫秒，p<0.01）以及相对于A2的长轴延长均恢复正常。舒张早期峰值延长速率增加（左室部位为7.5（2.1）厘米/秒对6.2（2）厘米/秒，间隔部位为6.3（2.4）厘米/秒对5.4（2.3）厘米/秒，p<0.001）。后壁舒张早期峰值变薄速率显著增加（10（3.5）厘米/秒对8（3）厘米/秒，p<0.005），二尖瓣E/A比值也增加（1.
