Takeda K, Takazawa K, Odani Y, Ibukiyama C
Second Department of Internal Medicine, Tokyo Medical College.
J Cardiol. 1998 Feb;31(2):75-82.
The relationship between left ventricular wall motion worsening (new asynergy; newly developed or worsened asynergy) in the affected part of old myocardial infarction during exercise two-dimensional echocardiography and the wall thickness at diastole was evaluated in 20 patients with more than 51% diameter stenosis in only the infarcted related artery using symptom-limited graded supine bicycle exercise test and two-dimensional echocardiography. End-diastolic wall thickness at normal part of the wall (WtdN) and infarcted parts (WtdI) on the parasternal short-axis view at the papillary muscle level at rest were measured and the wall thickness ratio, WtdI/WtdN x 100(%), was calculated. The rate pressure product at the time when new asynergy appeared and the appearance time of new asynergy after starting exercise were measured in seconds. Mean values for the 20 patients were wall thickness ratio of 75.7 +/- 10.0% (mean +/- SD), new asynergy appearance time of 219 +/- 116 sec after exercise and rate pressure product of 14,209 +/- 2,997 mmHg. beat/min. Smaller wall thickness ratio was associated with lower rate pressure product levels (r = 0.696, p < 0.01) and shorter appearance time of new asynergy (r = 0.772, p < 0.01). There was no significant correlation between the percentage diameter stenosis of the infarct-related artery and appearance time of new asynergy or rate pressure product. New asynergy appeared at a specific infarcted part of the wall, and thinner walls were associated with shorter appearance time of new asynergy with lower rate pressure product levels, regardless of the severity of stenosis of the infarct-related artery.
采用症状限制分级仰卧位自行车运动试验和二维超声心动图，对20例仅梗死相关动脉直径狭窄超过51%的患者进行评估，以探讨陈旧性心肌梗死受累部位在运动二维超声心动图检查时左心室壁运动恶化（新的运动不协调；新出现或恶化的运动不协调）与舒张末期壁厚之间的关系。在静息状态下，于乳头肌水平的胸骨旁短轴视图测量正常心肌壁部分（WtdN）和梗死心肌壁部分（WtdI）的舒张末期壁厚，并计算壁厚比值WtdI/WtdN×100（%）。测量新出现运动不协调时的心率血压乘积以及运动开始后新出现运动不协调的时间（以秒为单位）。20例患者的平均值为壁厚比值75.7±10.0%（平均值±标准差），运动后新出现运动不协调的时间为219±116秒，心率血压乘积为14209±2997mmHg·次/分钟。较小的壁厚比值与较低的心率血压乘积水平相关（r = 0.696，p < 0.01）以及新出现运动不协调的时间较短（r = 0.772，p < 0.01）。梗死相关动脉直径狭窄百分比与新出现运动不协调的时间或心率血压乘积之间无显著相关性。新的运动不协调出现在特定的梗死心肌壁部位，且壁越薄与新出现运动不协调的时间越短以及心率血压乘积水平越低相关，而与梗死相关动脉狭窄的严重程度无关。
