Krogmann O N, Traber J, Jakob M, Schneider J, Turina M, Hess O M
Department of Pediatric Cardiology, Heinrich-Heine-University, Düsseldorf, Germany.
Coron Artery Dis. 1998;9(5):239-48. doi: 10.1097/00019501-199809050-00001.
To assess the influence of myocardial structure and pericardial constraint during exercise ischemia on regional left ventricular passive elastic properties.
Left ventricular regional function was assessed at rest and during exercise using biplane angiography and high-fidelity pressure measurements. Twenty patients with either normal (n = 7) or stenotic coronary arteries (n = 13) were studied before and after successful bypass surgery. At the time of surgery, left ventricular transmural biopsies were taken from a normally perfused and a hypoperfused left ventricular region.
Regional stiffness increased in the ischemic zone during exercise, but remained unchanged after revascularization. Regional fibrosis was significantly enhanced in the ischemic region compared with that in the normally perfused zone. No correlation was found between structural data and regional passive elastic properties, but there was a significant correlation between right atrial pressure and the asymptote of the diastolic pressure--volume relationship.
Acute regional diastolic dysfunction can be observed during exercise in patients with coronary artery disease. Structural changes seem to have a minor role in the occurrence of diastolic dysfunction in the absence of myocardial infarction. The observed upward shift of the pressure-volume relationship during ischemia can be attributed to pericardial constraint that is manifested by an increase in right arterial pressure.
评估运动性心肌缺血期间心肌结构和心包限制对左心室局部被动弹性特性的影响。
使用双平面血管造影和高保真压力测量法在静息和运动期间评估左心室局部功能。对20例冠状动脉正常（n = 7）或狭窄（n = 13）的患者在成功进行搭桥手术前后进行研究。手术时，从正常灌注和灌注不足的左心室区域获取左心室透壁活检组织。
运动期间缺血区的局部僵硬度增加，但血运重建后保持不变。与正常灌注区相比，缺血区的局部纤维化明显增强。在结构数据与局部被动弹性特性之间未发现相关性，但右心房压力与舒张压-容积关系的渐近线之间存在显著相关性。
冠心病患者在运动期间可观察到急性局部舒张功能障碍。在无心肌梗死的情况下，结构变化似乎在舒张功能障碍的发生中起次要作用。缺血期间观察到的压力-容积关系上移可归因于心包限制，其表现为右动脉压升高。
