Jikuhara T, Sumimoto T, Tarumi N, Yuasa F, Hattori T, Sugiura T, Iwasaka T
Second Department of Internal Medicine, Kansai Medical University, Osaka, Japan.
Chest. 1997 Apr;111(4):922-8. doi: 10.1378/chest.111.4.922.
To examine the relation between left atrial (LA) function and exercise performance.
Retrospective study at a referral cardiopulmonary exercise laboratory in a university hospital.
Forty-one patients with recent myocardial infarction.
M-mode echocardiography and cardiopulmonary exercise testing combined with radionuclide ventriculography.
Hemodynamic measurements were obtained at rest and peak exercise. LA fractional shortening at rest was used as an index of global LA function. LA fractional shortening had fair correlations with peak oxygen consumption (r=0.67, p<0.01) and exercise duration (r=0.71, p<0.01). Although there were no significant relations between LA fractional shortening and hemodynamic measurements at rest, LA fractional shortening was positively related to peak cardiac output (r=0.61, p<0.01) and peak stroke volume (r=0.57, p<0.01), and negatively related to peak pulmonary arterial wedge pressure (r=-0.44, p<0.05). In addition, LA fractional shortening correlated significantly with an increase in left ventricular (LV) end-diastolic volume from rest to peak exercise (r=0.48, p<0.02), but did not correlate with the changes in ejection fraction and end-systolic volume during exercise. An increase in LV end-diastolic volume during exercise was significantly related to peak oxygen consumption (r=0.46, p<0.02), peak cardiac output (r=0.60, p<0.01), and peak stroke volume (r=0.53, p<0.01), whereas the changes in ejection fraction and end-systolic volume during exercise were not related to these indexes.
Exercise capacity and LV performance during exercise were mainly dependent on LV diastolic filling rather than systolic contraction during exercise. LA fractional shortening at rest reflected LV diastolic filling during exercise and, therefore, predicted cardiac output and stroke volume responses to exercise and exercise capacity in patients with recent myocardial infarction.
探讨左心房（LA）功能与运动能力之间的关系。
在一所大学医院的心肺运动转诊实验室进行的回顾性研究。
41例近期心肌梗死患者。
M型超声心动图、心肺运动试验联合放射性核素心室造影。
在静息和运动峰值时进行血流动力学测量。静息时的左心房缩短分数用作整体左心房功能的指标。左心房缩短分数与峰值耗氧量（r = 0.67，p < 0.01）和运动持续时间（r = 0.71，p < 0.01）具有中等程度的相关性。虽然静息时左心房缩短分数与血流动力学测量值之间无显著关系，但左心房缩短分数与峰值心输出量（r = 0.61，p < 0.01）和峰值每搏输出量（r = 0.57，p < 0.01）呈正相关，与峰值肺动脉楔压呈负相关（r = -0.44，p < 0.05）。此外，左心房缩短分数与静息至运动峰值时左心室（LV）舒张末期容积的增加显著相关（r = 0.48，p < 0.02），但与运动期间射血分数和收缩末期容积的变化无关。运动期间左心室舒张末期容积的增加与峰值耗氧量（r = 0.46，p < 0.02）、峰值心输出量（r = 0.60，p < 0.01）和峰值每搏输出量（r = 0.53，p < 0.01）显著相关，而运动期间射血分数和收缩末期容积的变化与这些指标无关。
运动能力和运动期间的左心室功能主要取决于运动期间的左心室舒张期充盈而非收缩期收缩。静息时的左心房缩短分数反映了运动期间的左心室舒张期充盈，因此可预测近期心肌梗死患者的心输出量和每搏输出量对运动的反应以及运动能力。
