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Nuklearmedizin 1993; 32(06): 282-287
DOI: 10.1055/s-0038-1632291
Originalarbeit
Schattauer GmbH

Linksventrikuläre Funktion während symptomatischer und asymptomatischer Myokardischämie

Left Ventricular Function During Episodes of Silent and Symptomatic Myocardial Ischemia
A. Hartmann
1   Aus der Abt. für Kardiologie, Zentrum der Inneren Medizin (Leiter: Prof. Dr. M. Kaltenbach), und der, FRG
,
F. D. Maul
2   Abt. für Nuklearmedizin, Zentrum der Radiologie (Leiter: Prof. Dr. G. Hör), Klinikum der J.-W.-Goethe-Universität Frankfurt/Main, FRG
,
M. Zimny
1   Aus der Abt. für Kardiologie, Zentrum der Inneren Medizin (Leiter: Prof. Dr. M. Kaltenbach), und der, FRG
,
H. Klepzig
1   Aus der Abt. für Kardiologie, Zentrum der Inneren Medizin (Leiter: Prof. Dr. M. Kaltenbach), und der, FRG
,
G. Hör
2   Abt. für Nuklearmedizin, Zentrum der Radiologie (Leiter: Prof. Dr. G. Hör), Klinikum der J.-W.-Goethe-Universität Frankfurt/Main, FRG
› Author Affiliations
Further Information

Publication History

Eingegangen: 23 June 1993

30 July 1993

Publication Date:
03 February 2018 (online)

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Zusammenfassung

Um zu untersuchen, ob sich Episoden stummer und symptomatischer Myokardischämie während transluminaler koronarer Angioplastie (PTCA) im Ausmaß der linksventrikulären (LV) Funktionsbeeinträchtigung unterscheiden, wurden Auswurffraktion (EF), Indices des endsystolischen und enddiastolischen Volumens (ESV EDV) sowie maximale Auswurf- (PER) und maximale Füllungsgeschwindigkeiten (PFR) vor und während PTCA kontinuierlich on-line mit einer nicht-bildgebenden Csl-Szintillationssonde bestimmt. 13 Patienten (Alter 54 ± 7,4 Jahre) waren symptomatisch, 10 Patienten (Alter 61 ±8 Jahre) waren asymptomatisch. Die linksventrikulären Funktionsparameter zeigten keine signifikanten Unterschiede zwischen den beiden Patientengruppen. Es wird daher gefolgert, daß symptomatische und stumme Ischämieepisoden während PTCA zu einer gleichartigen Beeinträchtigung der systolischen und diastolischen LV-Funktion führen. Somit kann während PTCA aufgrund der klinischen Symptomatik nicht auf das Ausmaß der LV-Funktionsstörung geschlossen werden.

Summary

Transluminal coronary angioplasty (PTCA) causes transient occlusion of the coronary artery and temporary ischemia of the left ventricle. Left ventricular dysfunction during silent and symptomatic episodes of myocardial ischemia during PTCA was evaluated continuously with a newly developed miniature, non-imaging scintillation probe. Parameters of left ventricular function were compared before and during balloon inflations of 60s duration: ejection fraction (EF), indices of end-systolic and end-diastolic volumes (ESV EDV), peak ejection and peak filling rates (PER, PFR). 13 patients (age 54 ± 7.4 years) were symptomatic, 10 patients (age 61 ± 8 years) were asymptomatic. Impairment of left ventricular function during ischemia did not show any significant differences between the symptomatic and asymptomatic patients. It is therefore concluded that symptomatic and asymptomatic episodes of myocardial ischemia during PTCA cause similar impairment of systolic and diastolic left ventricular function. The degree of left ventricular dysfunction during PTCA cannot be estimated on the basis of clinical symptoms.

Schlüsselwörter

Stumme Ischämie - LV-Funktion - PTCA - Radionuklidventrikulographie

Key words

Silent ischemia - PTCA - radionuclide ventriculography - left ventricular function

Herrn Prof. Dr. Kaltenbach zum 65. Geburtstag


 

  • LITERATUR

  • 1 Bonow RO, Leon MB, Rosing DR, Kent KM, Lipson LC, Bacharach SL, Green MV, Epstein SE. Effects of verapamil and propranolol on left ventricular systolic function and diastolic filling in patients with coronary artery disease: radionuclide angiographic studies et rest and during exercise Circulation. 1982; 65: 1337-50.
    Search in Google Scholar
  • 2 Broadhurst P, Cashman P, Crawley J, Raferty EB, Lahiri A. Clinical validation of a miniature nuclear probe system for continuous on-line monitoring of cardiac function and ST-segment. J Nucl Med 1991; 32: 37-43.
    PubMedSearch in Google Scholar
  • 3 Bruyne B, Lerch R, Meier B, Schlaepfer H, Gabathuler J, Rutishauser W. Doppler assessment of left ventricular diastolic filling during brief coronary occlusion. Am Heart J 1989; 117: 629-35.
    CrossrefPubMedSearch in Google Scholar
  • 4 Carlson EB, Hinohara T, Morris KG. Recovery of systolic and diastolic left ventricular function after a 60-second coronary arterial occlusion during percutaneous transluminal coronary angioplasty for angina pectoris. Am J Cardiol 1987; 60: 460-6.
    CrossrefPubMedSearch in Google Scholar
  • 5 Chierchia S, Lazzari M, Freedman B, Brunelli C, Maseri A. Impairment of myocardial perfusion and function during painless myocardial ischemia. J Am Coll Cardiol 1983; 01: 924-30.
    CrossrefPubMedSearch in Google Scholar
  • 6 Cohn PF. Silent myocardial ischemia in patients with a defective anginal warning system. Am J Cardiol 1980; 45: 697-702.
    CrossrefPubMedSearch in Google Scholar
  • 7 Cohn PF. Asymptomatic coronary artery disease. Mod Cone Cardiovasc Dis 1981; 50: 55-60.
    Search in Google Scholar
  • 8 Cohn PF, Brown EJ, Wynne J, Holman BL, Atkins HL. Global and regional left ventricular ejection fraction abnormalities during exercise in patients with silent myocardial ischemia. J Am Coll Cardiol 1983; 01: 931-3.
    CrossrefPubMedSearch in Google Scholar
  • 9 Denys BG, Uretsky BF, Ruffner RF, Reddy PS, Sandhu JS, Breisblatt WM. Silent ischemia during coronary angioplasty detection by the intracoronary electrocardiogram. Eur Heart J 1990; 11 Abst. suppl. 376.
    Search in Google Scholar
  • 10 Droste C, Roskamm H. Experimental pain measurement in patients with asymptomatic myocardial ischemia. J Am Coll Cardiol 1983; 01: 940-5.
    CrossrefPubMedSearch in Google Scholar
  • 11 Falcone C, Specchia G, Rondanelli R, Guasti L, Corsico G, Codega S, Montemartini C. Correlation between beta-endorphin plasma levels and anginal symptoms in patients with coronary artery disease. J Am Coll Cardiol 1988; 11: 719-23.
    CrossrefPubMedSearch in Google Scholar
  • 12 Glazier JJ, Chierchia S, Brown MJ, Maseri A. Importance of generalized defective perception of painful stimuli as a causc of silent myocardial ischemia in chronic stable angina pectoris. Am J Cardiol 1986; 58: 667-72.
    CrossrefPubMedSearch in Google Scholar
  • 13 Hartmann A, Eggert C, Kaltenbach M. Vergleich von Sauerstoffschuld und Ischämicschmerzschwclle bei Patienten mit stummer und symptomatischer myokardialer Belastungsischämie. Z Kardiol 1990; 79: 23-7.
    PubMedSearch in Google Scholar
  • 14 Hartmann A, Maul FD, Zimny M, Klepzig H, Vallbracht C, Kneissl HG, Schräder R, Hör G, Kaltenbach M. Impairment of left ventricular function during coronary angioplastic occlusion evaluated with a non-imaging scintillation probe. Am J Cardiol 1991; 68: 598-602.
    CrossrefPubMedSearch in Google Scholar
  • 15 Hör G, Kanemoto N, Standke R, Maul FD, Klepzig H, Kober G, Kaltenbach M. Transluminale Angioplastik: Erfolgskontrolle durch Verfahren der Nuklearmedizin nach nicht-operativer Dilatation kritischer Koronararterienstenosen. Herz 1980; 05: 168-76.
    Search in Google Scholar
  • 16 Hör G, Kober G, Maul FD, Klepzig H, Standke R, Bittner G, Kanemoto N, Happ J, Baum RP. Nuclear cardiology results before and after percutaneous transluminal coronary angioplasty (PTCA): 1978-1986. Nucl Med Comm 1987; 08: 127-37.
    CrossrefPubMedSearch in Google Scholar
  • 17 Iskandrian A, Hakki A. Left ventricular function in patients with coronary heart disease in the presence or absence of angina pectoris during exercise radionuclide ventriculography. Am J Cardiol 1984; 53: 1239-43.
    CrossrefPubMedSearch in Google Scholar
  • 18 Kaltenbach M, Vallbracht C, Kober G. Long wire technique – experience with 1000 procedures. Z Kardiol 1987; 76 (Suppl. 06) 53-7.
    PubMedSearch in Google Scholar
  • 19 Kass DA, Midei M, Brinker J, Maughan WL. Influence of coronary occlusion during PTCA on end-systolic and end-diastolic pressure-volume relations in humans. Circulation 1990; 81: 447-60.
    CrossrefPubMedSearch in Google Scholar
  • 20 Kayden DS, Suzuki A, Wackers FJ, Zared BL. Validation of continuous radionuclide ventricular function monitoring by demonstration of ventricular dysfunction during coronary angioplasty. J Nucl Med 1989; 30: 771 (abst).
    Search in Google Scholar
  • 21 Kent KM, Bonow RO, Rosing DR, Ewels CJ, Lipson LC, McIntosh CL, Bacharach S, Green M, Epstein SE. Improved myocardial function during exercise after successful percutaneous transluminal coronary angioplasty. N Engl J Med 1982; 306: 441-6.
    CrossrefPubMedSearch in Google Scholar
  • 22 Lahiri A, Bowles MJ, Jones RI, Crawley JCW, Raferty EB. Assessment of left ventricular function in coronary artery disease with the nuclear probe during intervention studies. Br Heart J 1984; 52: 422-30.
    CrossrefPubMedSearch in Google Scholar
  • 23 Lahiri A, Rodrigues EA, Carboni GP, Raferty EB. Effects of long-term treatment with calcium antagonists on left ventricular diastolic function in stable angina and heart failure. Circulation 1990; 81 (Suppl III): 130-8.
    Search in Google Scholar
  • 24 Nishimura S, Lacy JL, Guidry GW, Mahmarian JJ, Verani MS. Functional significance of angina during coronary angioplasty. J Nucl Med 1990; 31: 843 (abst).
    Search in Google Scholar
  • 25 Schang SJ, Pepine CJ. Transient asymptomatic ST segment depression during daily activity. Am J Cardiol 1977; 339: 396-402.
    Search in Google Scholar
  • 26 Sclwyn A, Fox K, Evcss M, Oakley D, Dargie H, Shillingford J. Myocardial ischemia in patients with frequent angina pectoris. Br Med 1978; 02: 1594-6.
    CrossrefPubMedSearch in Google Scholar
  • 27 Wagner HN, Rigo P, Baxter RH, Alderson PO, Douglass PO, Housholder DF. Monitoring ventricular function at rest and during exercise with a nonimaging nuclear detector. Am J Cardiol 1979; 43: 975-9.
    CrossrefPubMedSearch in Google Scholar
  • 28 Wohlgelernter D, Jaffe CC, Cabin HS, Ycatman LA, Cleman M. Silent ischemia during coronary occlusion produced by balloon inflation: relation to regional myocardial dysfunction. J Am Coll Cardiol 1987; 10: 491-8.
    CrossrefPubMedSearch in Google Scholar