Stack R S, Lee C C, Reddy B P, Taylor M L, Weissler A M
Am J Cardiol. 1976 Mar 4;37(3):331-9. doi: 10.1016/0002-9149(76)90280-0.
Simultaneous determinations of systolic time intervals (preejection period index [PEPI], left ventricular ejection time index [LVETI] and ratio of preejection period to left ventricular ejection time [PEP/LVET]) and echographic measures of left ventricular performance (percent change in minor axis diameter [%delta D], circumferential shortening rate [Vcf] and end-diastolic diameter [Dd]) were obtained in 25 normal subjects and 37 patients with previously documented transmural myocardial infarction. The group with previous infarction demonstrated significant (P less than 0.001) differences from the normal group in each of the noninvasive measures. PEP/LVET and %deltaD were the most sensitive measures of left ventricular dysfunction. Deviation from the normal range in these measures occurred, respectively, in 70 and 65 percent of patients without dyspnea or fatigability (20 patients) and 85 percent of those without angina pectoris (13 patients). Abnormalities in systolic time interval and echocardiographic measures were related to the severity of dyspnea and fatigability but not to that of angina. Neither the presence of phonocardiographically documented third or fourth sound gallops nor an abnormal cardiothoracic ratio by chest roentgenogram reliably detected patients with abnormal left ventricular performance. The range of abnormality in left ventricular performance did not differ between patients with prior anterior or diaphragmatic myocardial infarction. The frequency of abnormal performance was greatest among patients with combined sites of prior infarction. Among 26 patients studied by coronary arteriography, abnormal left ventricular performance as determined by values for PEP/LVET and %deltaD occurred in fewer than 30 percent of those with 70 percent or greater obstruction of one coronary artery and in more than 80 percent of those with two or three vessel involvement. There was a high correlation between systolic time intervals, %delta D and Vcf, the closest correlation occurring between PEP/LVET and %deltaD (r = -0.93). These data document the sensitivity of the noninvasive systolic time intervals and echographic measures and their superiority over current clinical bedside methods in evaluating left ventricular performance in patients with prior myocardial infarction.
对25名正常受试者和37名既往有透壁性心肌梗死记录的患者，同时测定了收缩期时间间期（射血前期指数[PEPI]、左室射血时间指数[LVETI]以及射血前期与左室射血时间之比[PEP/LVET]）和左室功能的超声心动图指标（短轴直径变化百分比[%ΔD]、圆周缩短率[Vcf]和舒张末期直径[Dd]）。既往有心肌梗死的患者组在各项非侵入性指标上与正常组相比均有显著差异（P<0.001）。PEP/LVET和%ΔD是左室功能障碍最敏感的指标。在无呼吸困难或乏力的患者（20例）中，这些指标偏离正常范围的发生率分别为70%和65%，在无心绞痛的患者（13例）中为85%。收缩期时间间期和超声心动图指标的异常与呼吸困难和乏力的严重程度相关，但与心绞痛的严重程度无关。心音图记录到的第三或第四心音奔马律的存在以及胸部X线片显示的心胸比率异常均不能可靠地检测出左室功能异常的患者。既往有前壁或膈面心肌梗死的患者左室功能异常的范围无差异。既往梗死部位合并的患者中异常功能的发生率最高。在26例接受冠状动脉造影的患者中，根据PEP/LVET和%ΔD值确定左室功能异常的情况，在单支冠状动脉阻塞70%或以上的患者中不到30%，在两支或三支血管受累的患者中超过80%。收缩期时间间期、%ΔD和Vcf之间存在高度相关性，PEP/LVET和%ΔD之间的相关性最为密切（r=-0.93）。这些数据证明了非侵入性收缩期时间间期和超声心动图指标的敏感性及其在评估既往心肌梗死患者左室功能方面优于目前的临床床边方法。
