左心室舒张功能不全在卧位型心绞痛发病中的作用

Effect of left ventricular diastolic dysfunction on pathogenesis of angina decubitus

目的 探讨左心室舒张功能不全在卧位型心绞痛 (AD)发病中的作用。方法 对 31例左心室射血分数 (LVEF) >5 0 %的AD患者和 2 0例具有同质可比性的冠心病非AD患者和 2 0例正常对照者的左心室造影 (LVG)资料进行了分析。结果 (1)AD组左心室舒张期前 1/3充盈分数为 0 .30± 0 .12 ,明显低于冠心病非AD组 (0 .41± 0 .12 ,P <0 .0 0 1)和对照组 (0 .46± 0 .0 7,P <0 .0 0 1) ,而左心室舒张期后 1/3充盈分数为 0 .36± 0 .0 9,明显高于冠心病对照组 (0 .31± 0 .0 8,P <0 .0 5 )和正常对照组 (0 2 9± 0 .0 6 ,P <0 .0 5 )。 (2 )左心室造影前和造影后的左心室舒张末压 (LVEDP)在AD组为 16mmHg± 5mmHg和 2 0mmHg± 5mmHg,冠心病对照组 (为 14mmHg± 5mmHg和 16mmHg± 5mmHg) ,均明显高于正常对照组 (10mmHg± 4mmHg和 12mmHg± 4mmHg)。左心房收缩使LVEDP升高差值 (LACD)在AD组亦显著高于正常对照组 (6 .4mmHg± 2 6mmHg与 4.1mmHg± 2 .2mmHg,P <0 .0 1)。然而左心室造影前与造影后自身比较 ,仅AD组LVEDP和LACD造影后明显升高。结论 左心室舒张功能不全是AD发病的主要病理因素。

Objective To investigate the effect of left ventricular diastolic dysfunction on the pathogenesis of angina decubitus. Methods The study population consisted of three groups: (1) group 1, 31 patients with angina decubitus who had ejection fraction>50%; (2) group 2, 20 patients with coronary artery disease but without angina decubitus; group 2 and 1 were matched for age, EF and extent of coronary artery disease; (3) group 3, 20 patients without cardiovascular diseases. Results Left ventriculography (LVG) showed that LV first 1/3 filling fraction (1/3 FF) and LV late 1/3 FF were 0.30±0.12, 0.41±0.12, 0.46±0.07 and 0.36±0 09, 0 31±0.08, 0.29±0.06 in groups 1 to 3 respectively. LV first 1/3 FF was significantly lower in group 1 than in group 2 and 3 (both P <0.001), but LV late 1/3 FF was much higher in group 1 than in groups 2 and 3 ( P <0.05 and P <0.01, respectively). Left ventricular end diastolic pressure (LVEDP) was markedly increased before and after LVG in groups 1 and 2 as compared with group 3 ( P <0.001 and P <0.05, respectively). The difference of LVEDP caused by left atrial contraction (LACD) was much higher before and after LVG in group 1 than in group 3 ( P <0.01 and P <0.001, respectively). However, there were significant differences in LVEDP and LACD tested between before and after LVG in group 1 (both P <0.01). No statistical differences were found in LVEDP and LACD tested between before and after LVG in both group 2 and group 3. Conclusion Patients with angina decubitus have LV diastolic dysfunction, which may be closely related to the pathogenesis of angina decubitus.