心肌病患者左心室射血分数对精神应激和运动的异常反应。

Abnormal left ventricular ejection fraction response to mental stress and exercise in cardiomyopathy.

作者信息

Wolz D E, Flores A R, Grandis D J, Orie J E, Schulman D S

机构信息

Department of Internal Medicine, Medical College of Pennsylvania, Allegheny General Hospital, Pittsburgh 15212, USA.

出版信息

J Nucl Cardiol. 1995 Mar-Apr;2(2 Pt 1):144-50. doi: 10.1016/s1071-3581(95)80025-5.

DOI:10.1016/s1071-3581(95)80025-5

PMID:9420779

Abstract

BACKGROUND

A decline in left ventricular (LV) ejection fraction in response to mental stress and exercise is regarded as an indicator of myocardial ischemia. In patients with LV dysfunction, the ejection fraction is sensitive to afterload, which increases during stress. Thus, the effects of mental stress and exercise on LV systolic function in patients with cardiomyopathy were examined.

METHODS

The ambulatory nuclear VEST (Capintec, Inc., Ramsey, N.J.) was used to monitor LV ejection fraction in patients with cardiomyopathy (10 idiopathic and 9 ischemic). Patients underwent a series of mental stress tests (serial 7s, Stroop color, and Paced auditory addition) and treadmill exercise. Heart rate, systolic blood pressure, and LV ejection fraction were measured.

RESULTS

Mental stress and exercise increased heart rate and systolic blood pressure. For idiopathic cardiomyopathy, LV ejection fraction decreased during serial 7s, Stroop color, Paced auditory addition and exercise by -8% +/- 6%, -7% +/- 5%, -7% +/- 3%, -9% +/- 10%, respectively. For ischemic cardiomyopathy, LV ejection fraction declined by -4% +/- 3%, -7% +/- 5%, -6% +/- 3%, -2% +/- 6% during the same stress tests. There was no difference between the idiopathic and ischemic groups. Each patient showed a 5% or greater decline in LV ejection fraction during one mental stress test. There was an inverse relation between changes in LV ejection fraction and systolic blood pressure during all mental stress tests and exercise (r = -0.47, p < 0.0001).

CONCLUSIONS

In patients with depressed baseline systolic function, the decline in systolic function during mental stress and exercise could be related in part to increases in LV afterload.

摘要

背景

左心室（LV）射血分数对精神应激和运动的下降被视为心肌缺血的指标。在左心室功能障碍患者中，射血分数对后负荷敏感，后负荷在应激时会增加。因此，研究了精神应激和运动对心肌病患者左心室收缩功能的影响。

方法

使用动态核素心室功能仪（VEST，Capintec公司，新泽西州拉姆齐）监测心肌病患者（10例特发性心肌病和9例缺血性心肌病）的左心室射血分数。患者接受了一系列精神应激测试（连续7秒、斯特鲁普颜色和节奏性听觉加法）和跑步机运动。测量心率、收缩压和左心室射血分数。

结果

精神应激和运动增加了心率和收缩压。对于特发性心肌病，在连续7秒、斯特鲁普颜色、节奏性听觉加法和运动期间，左心室射血分数分别下降了-8%±6%、-7%±5%、-7%±3%、-9%±10%。对于缺血性心肌病，在相同的应激测试期间，左心室射血分数下降了-4%±3%、-7%±5%、-6%±3%、-2%±6%。特发性和缺血性组之间没有差异。在一项精神应激测试中，每位患者的左心室射血分数下降了5%或更多。在所有精神应激测试和运动期间，左心室射血分数的变化与收缩压呈负相关（r = -0.47，p < 0.0001）。