卧位型心绞痛患者的左心室舒张功能异常

LEFT VENTRICULAR DIASTOLIC DYSFUNCTION IN PATIENTS WITH ANGINA DECUBITUS

为探讨左心室舒张功能异常与卧位型心绞痛发作的关系，对２４例冠心病卧位型心绞痛患者、２０例冠心病非卧位型心绞痛患者和２０例正常人的左心室造影资料进行分析，发现卧位型心绞痛患者左心室舒张期前１／３充盈率明显低于冠心病对照组（Ｐ＜０．００１）和正常对照组（Ｐ＜０．００１），其左心室造影后的左心室舒张未压（ＬＶＥＤＰ）较之造影前亦显著升高（Ｐ＜０．０１），而冠心病对照组和正常对照组造影前后的ＬＶＥＤＰ差异无显著性。结果表明卧位型心绞痛患者存在明显的左心室舒张功能不全。

ur study population consisted of three groups:①24 cases with ejection fraction(EF)>45% in 26patients with angina decubitus(AD)were studied as group A.②20 patients had coronary artery diseasewithout AD as group B. Group B and A were matched for age, EF and coronary artery obstructive lesions.③20 cases without cardiovascular diseases as group C. Left ventriculography(LVG ) was performed inthese patients. The results showed that left ventricular(LV)early 1/3 filling fraction (1/3FF)was signi-ficantly reduced in group A as compared with that in group B and C (both P<0. 001).The findings sug-gest that patients with AD have abnormalities of LV diastolic filling.Left ventricular end diastolic pressure(LVEDP)significantly increased in patients with AD after LVG as compared with before LVG ( P<0. 01 ).However,there was no statistically difference in LVEDP before and after LVG in both group Band C, indicating that the compliance of LV was also decreased in patients with AD. The increase of LVvo-lume after recumbency would cause increase of LV wall tension and myocardial contraction and aggra-vate the LV diastolic dysfunction ’resulting in a progressive increase in myocardial oxygen consumption.Therefore,we consider that on the basis of severe coronary artery obstructive lesions, LV diastolic dys-function is a significant pathologic factor in the pathogenesis of AD.