Kimball B P, Bui S, Wigle E D
Department of Medicine, Toronto Hospital, Ontario, Canada.
Am Heart J. 1993 Jun;125(6):1691-7. doi: 10.1016/0002-8703(93)90760-7.
To evaluate the acute hemodynamic effects of intravenous disopyramide in hypertrophic obstructive cardiomyopathy (HOCM), 25 patients (12 men, 13 women) with an average age of 40 years (range 18 to 70 years) were evaluated while undergoing cardiac catheterization-angiography. Biplane left ventricular angiography was performed with standard intracardiac-systemic hemodynamics, including resting and provoked (after ventricular premature beat) left ventricular outflow tract gradients, by using simultaneous LV and aortic pressures as disopyramide was being administered (total dose 100 mg, bolus 10 mg every 3 minutes). Average baseline thermodilution cardiac output equalled 4.5 +/- 1.2 L/min, with all 25 subjects demonstrating systolic anterior motion of the mitral apparatus (mild, 3 [12%]; moderate, 8 [32%]; severe, 14 [64%]). Although heart rate originally slowed during disopyramide administration, average heart rate increased during the final stages (before, 78 +/- 15 vs after, 82 +/- 13 beats/min; p < 0.05). Systemic aortic pressures increased during intravenous disopyramide (before, 107 +/- 21/71 +/- 19 mm Hg vs after, 120 +/- 28/81 +/- 13 mm Hg; p < 0.05), with a decline in LV end-diastolic pressure (before, 19 +/- 7 vs after, 16 +/- 6 mm Hg; p < 0.01). Maximum LV systolic pressures decreased (before, 193 +/- 32 vs after, 146 +/- 29 mm Hg; p < 0.01), with a substantial reduction in resting LV outflow tract gradients (before, 86 +/- 34 vs after, 27 +/- 20 mm Hg; p < 0.001) in conjunction with less inducible obstruction (before, 124 +/- 33 vs after, 64 +/- 33 mm Hg; p < 0.001). Only minor electrocardiographic changes were seen during disopyramide infusion.(ABSTRACT TRUNCATED AT 250 WORDS)
为评估静脉注射双异丙吡胺对肥厚性梗阻性心肌病（HOCM）的急性血流动力学影响，对25例患者（12例男性，13例女性）进行了评估，平均年龄40岁（范围18至70岁），这些患者正在接受心脏导管血管造影检查。采用标准的心内系统血流动力学进行双平面左心室血管造影，包括静息和激发状态（室性早搏后）的左心室流出道梯度，在静脉注射双异丙吡胺（总剂量100mg，每3分钟推注10mg）时同步记录左心室和主动脉压力。平均基础热稀释心输出量为4.5±1.2L/分钟，所有25例受试者均表现出二尖瓣装置的收缩期前向运动（轻度，3例[12%]；中度，8例[32%]；重度，14例[64%]）。尽管在注射双异丙吡胺期间心率最初减慢，但在最后阶段平均心率增加（注射前，78±15次/分钟 vs 注射后，82±13次/分钟；p<0.05）。静脉注射双异丙吡胺期间主动脉系统压力升高（注射前，107±21/71±19mmHg vs 注射后，120±28/81±13mmHg；p<0.05），左心室舒张末期压力下降（注射前，19±7 vs 注射后，16±6mmHg；p<0.01）。左心室最大收缩压下降（注射前，193±32 vs 注射后，146±29mmHg；p<0.01），静息左心室流出道梯度大幅降低（注射前，86±34 vs 注射后，27±20mmHg；p<0.001），同时可诱导梗阻减轻（注射前，124±33 vs 注射后，64±33mmHg；p<0.001）。在注射双异丙吡胺期间仅观察到轻微的心电图变化。（摘要截短至250字）
