左心室局部收缩及舒张不协调性对左心室整体舒张功能的影响

Effect of left ventricular regional mechanical nonuniformity on global diastolic function

作者用放射性核素左心室造影方法，研究了正常人心绞痛及心肌梗死患者左心室局部收缩（局部射血分数，ＲＥＦ）及舒张功能（高峰充盈率，ＰＦＲ），对比不同患者的左心室局部收缩及舒张不协调分数对整体左心室舒张功能的影响。结果显示正常人组的左心室各局部存在着机械功能的不协调性，其中以舒张不协调性明显；心绞痛组左心室内部舒张不协调性比正常人增加，而心肌梗死患者，特别是有室壁瘤形成的患者，左心室内部收缩及舒张不协调性均明显增加，局部不协调分数与左心室ＰＦＲ呈负相关。提示：正常人的左心室局部各个区域的心肌收缩及舒张均存在着不一致性。当心肌缺血发生后，随着缺血程度的加重；室壁运动异常也加重，当矛盾性室壁运动出现后，更加重了心肌的不协调性。

Radionuclide left ventricular imaging was used to evaluate the regional systolic and diastolic function(Regional Ejection Fraction,REF) and the global diastolic function (Peak Filling Rate,PFR) of the left ventricle in both normal controls in both regional contractible and relaxant synchronous fractions and their relation to global relaxant function. The results showed that in the normal controls, there was mechanical nonuniformity in the left ventricle,with the diastolic synchronous fraction more obvious. The diastolic nonuniformity was more significant in patients with angina pectoris than in the normal controls. In patients with myocardial infarction,especially in those with aneurysm,the systolic and diastolic nonuniformity was severer and the regional asynchronous fraction was negatively related to left ventricular PFR. It is concluded that there was nonuniformity in different regions of the left ventricle in the normal,and that when myocardial ischemia occurred,necrosis grew increasingly worse with the aggravation of the ischemia,thus further increasing the regional myocardial nonuniformity. The results may also suggest that the regional asynchronous fraction is an important factor affecting left ventricular diastolic function.