Paz R, Jortner R, Tunick P A, Sclarovsky S, Eilat B, Perez J L, Kronzon I
Beilinson Hospital, Petah Tiqvah, Israel.
N Engl J Med. 1996 Sep 26;335(13):938-41. doi: 10.1056/NEJM199609263351305.
Ethanol causes vasodilation, which might have an adverse effect, due to increased obstruction of the left ventricular outflow tract, in patients with hypertrophic obstructive cardiomyopathy. We assessed the hemodynamic effects of the ingestion of ethanol, in an amount commonly consumed socially, in patients with hypertrophic cardiomyopathy.
We performed echocardiography in 36 patients before and several times after the ingestion of either 50 ml of 40 percent ethanol or an isocaloric placebo with the aroma of rum. Each patient received both ethanol and placebo, on different days. The patients, but not the physicians, were blinded to the content of the drink. We measured the sizes of the left atrium and left ventricle, the left-ventricular-wall thickness, blood pressure, heart rate, the degree of systolic anterior motion of the mitral valve, and the pressure gradient across the left ventricular outflow tract.
The ingestion of ethanol regulated in a significant drop in the mean (+/- SD) systolic blood pressure (from 130.5 +/- 18.6 to 122.5 +/- 20.3 mm Hg, P<0.001), a significant increase in systolic anterior motion of the mitral valve (from a grade of 2.1 to a grade of 2.5, P<0.001), and a 63 percent increase in the mean gradient across the left ventricular outflow tract (from 38.1 +/- 26.5 to 62.2 +/- 42.4 mm Hg, P<0.001). These changes, which were not associated with symptoms, did not occur after the ingestion of placebo.
The ingestion of a small amount of ethanol caused an increase in the gradient across the left ventricular outflow tract in patients with hypertrophic obstructive cardiomyopathy, which could have and adverse clinical effect.
乙醇可导致血管舒张，这可能会因肥厚性梗阻性心肌病患者左心室流出道梗阻加重而产生不良影响。我们评估了肥厚性心肌病患者摄入社交场合常见量乙醇后的血流动力学效应。
我们对36例患者在摄入50毫升40%乙醇或具有朗姆酒香气的等热量安慰剂之前及之后多次进行超声心动图检查。每位患者在不同日期分别接受乙醇和安慰剂。患者对饮品内容不知情，但医生知情。我们测量了左心房和左心室大小、左心室壁厚度、血压、心率、二尖瓣收缩期前向运动程度以及左心室流出道的压力阶差。
摄入乙醇导致平均（±标准差）收缩压显著下降（从130.5±18.6毫米汞柱降至122.5±20.3毫米汞柱，P<0.001），二尖瓣收缩期前向运动显著增加（从2.1级升至2.5级，P<0.001），左心室流出道平均压力阶差增加63%（从38.1±26.5毫米汞柱增至62.2±42.4毫米汞柱，P<0.001）。这些变化与症状无关，摄入安慰剂后未出现。
摄入少量乙醇会导致肥厚性梗阻性心肌病患者左心室流出道压力阶差增加，这可能会产生不良临床影响。
