Geskin G, Schulman D S
Department of Internal Medicine, Allegheny University, Allegheny General Hospital, Pittsburgh, Pennsylvania 15212, USA.
Am J Cardiol. 1997 Nov 1;80(9):1144-9. doi: 10.1016/s0002-9149(97)00630-9.
Patients with systemic hypertension and coronary artery disease (CAD) often manifest abnormalities at rest in left ventricular (LV) diastolic function and reduced exercise tolerance. It is possible that abnormalities in filling persist during exercise and are partially related to abnormal exercise tolerance. We examined rest and exercise peak filling rate (PFR) to determine if changes in PFR during exercise influence exercise performance. We studied 20 patients with systemic hypertension who had no evidence of CAD (negative thallium-201 stress imaging) and 15 patients with prior myocardial infarction, preserved ejection fraction, and no ischemia by thallium-201 stress imaging. Results were compared with 20 normal subjects. All 55 subjects had rest and exercise radionuclide angiograms Peak workload, exercise time, and LV ejection fraction were reduced in subjects with CAD (57 +/- 24 W, 7.41 +/- 2.91 min, and 60 +/- 9%) compared with subjects with hypertension (72 +/- 21 W, 9.69 +/- 3.03 min, and 70 +/- 6%, p <0.05) and controls (80 +/- 30 W, 10.82 +/- 3.50 min, and 67 +/- 6%, p <0.05). PFR at rest was reduced in CAD subjects (2.40 +/- 0.70 end-diastolic volume per second [EDV/s]) compared with those with hypertension (2.89 +/- 0.70 EDV/s, p <0.02) and controls (3.23 +/- 0.52 EDV/s, p <0.0002). The increments in PFR during exercise were reduced in CAD patients (+1.76 +/- 0.95 EDV/s) compared with hypertensive subjects (+2.93 +/- 1.7 EDV/s) and controls (+3.22 +/- 1.4 EDV/s, p <0.05). The increment in PFR during exercise was related to exercise performance (r = 0.49, p <0.0002). These findings suggest that alterations in LV diastolic filling during exercise are important determinants of exercise performance.
患有系统性高血压和冠状动脉疾病（CAD）的患者在静息状态下常表现出左心室（LV）舒张功能异常以及运动耐力下降。运动期间充盈异常可能持续存在，且部分与异常的运动耐力有关。我们检查了静息和运动时的峰值充盈率（PFR），以确定运动期间PFR的变化是否会影响运动表现。我们研究了20例无CAD证据（铊-201负荷显像阴性）的系统性高血压患者以及15例既往有心肌梗死、射血分数保留且铊-201负荷显像无缺血表现的患者。将结果与20名正常受试者进行比较。所有55名受试者均进行了静息和运动放射性核素血管造影。与高血压患者（72±21W，9.69±3.03分钟，70±6%）和对照组（80±30W，10.82±3.50分钟，67±6%）相比，CAD患者的峰值工作量、运动时间和左心室射血分数降低（57±24W，7.41±2.91分钟，60±9%，p<0.05）。与高血压患者（2.89±0.70舒张末期容积每秒[EDV/s]）和对照组（3.23±0.52 EDV/s）相比，CAD患者静息时的PFR降低（2.40±0.70 EDV/s，p<0.02，p<0.0002）。与高血压受试者（+2.93±1.7 EDV/s）和对照组（+3.22±\u200b\u200b1.4 EDV/s，p<0.05）相比，CAD患者运动期间PFR的增加幅度降低（+1.76±0.95 EDV/s）。运动期间PFR增加与运动表现相关（r=0.49，p<0.0002）。这些发现表明，运动期间左心室舒张期充盈的改变是运动表现的重要决定因素。
