Adrenergic Effects on Left Ventricular Functions in Coronary Patients after Successful Coronary Angioplasty: An Assessment with Radionuclide Ventriculography

以放射核種心室造影術評估經皮冠狀動脈成形術后于腎上腺素性藥物作用下之左心室功能變化

鄭澄意(Cheng-Yi Cheng) ； 楊世平(Shih-Ping Yang) ； 諶鴻遠(Hung-Yuan Shen) ； 樊裕明(Yu-Ming Fan) ； 張宏達(Hong-Da Chang) ； 黃文盛(Wen-Sheng Huang)

《核子醫學雜誌》 16卷2期 (2003/06) Pp. 65-72

https://doi.org/10.6332/ANMS.1602.003

摘要

Background: The purpose of this investigation was to study the effects of adrenergic stimulation on left ventricular systolic and diastolic functions in the patients with coronary artery disease(CAD)and following successful percutaneous transluminal coronary angioplasty(PTCA).Methods: Twelve normal subjects(M8,F4;aged 61±7)and twenty-three patients(M16,F7;aged 62±7)with CAD and successful PTCA were included for dobutamine stress radionuclide ventriculography(RNV). Dobutamine infusion was started at 5μg/kg/minwith the increment of 5μg/kg/min every 10 min until angina, high blood pressure(systolic BP＞210 mm Hg)or maximum dose was achieved(20μg/kg/min).RNV was performed before dobutamine infusion and at each dose level of dobutamine infusion. Parameters of left ventricular systolic function(ejection fraction, EF; peakejection rate, PER)and diastolic function(peak filling rate, PFR; Time to peak filling rate, TPFR)were determined by computer analysis of left ventricular time activity curve. Results: During dobutamine infusion in normal subjects, the left ventricular systolic and diastolic functions changed significantly from baseline to the dobutamine infusion rate at 20μg/kg/min(EF:59±6% to 69±7%,P＜0.05;PER:3.2±0.5 to 5.2±0.7 end-diastolic volumes/sec,P＜0.05;PFR:3.1±0.5 to 4.7±0.6 enddiastolic volumes/sec,P＜0.05;TPFR:140±30 to 100±36 msec,P＜0.05)The CAD patients, before PTCA, demonstrated left ventricular diastolic dysfunction(EF:56±4% to 63±6%,P＜0.05;PER:3.0±0.4 to 4.2±0.5 end-diastolic volumes/sec,P＜0.05;PFR:2.8±0.4to 2.6±0.6 end-diastolic volumes/sec,NS;TPFR:170±33 to 250±56 msec, P＜0.05).However, after successful PTCA, left ventricular functions response to dobutamine infusion were restored(EF:58±7% to 67±8%,P＜0.05;PER:3.1±0.5 to 4.5±0.4 end-diastolic volumes/sec, P＜0.05;PFR:3.0±0.5 to 4.3±0.5end-diastolic volumes/sec, P＜0.01;TPFR:151±50 to123±33 msec, P＜0.05)Conclusions: RNV is an easily performed and valuable method in the evaluation of the adrenergic effects on left ventricular functions in CAD patients before and after successful coronary angioplasty. Left ventricular diastolic dysfunction induced by dobutamine infusion can be restored by successful PTCA in coronary patients.

關鍵字

多嘌它命 ； 冠狀動脈疾病 ； 冠狀動脈成形術 ； 放射核種心室造影術

並列摘要

Background: The purpose of this investigation was to study the effects of adrenergic stimulation on left ventricular systolic and diastolic functions in the patients with coronary artery disease(CAD)and following successful percutaneous transluminal coronary angioplasty(PTCA).Methods: Twelve normal subjects(M8,F4;aged 61±7)and twenty-three patients(M16,F7;aged 62±7)with CAD and successful PTCA were included for dobutamine stress radionuclide ventriculography(RNV). Dobutamine infusion was started at 5μg/kg/minwith the increment of 5μg/kg/min every 10 min until angina, high blood pressure(systolic BP＞210 mm Hg)or maximum dose was achieved(20μg/kg/min).RNV was performed before dobutamine infusion and at each dose level of dobutamine infusion. Parameters of left ventricular systolic function(ejection fraction, EF; peakejection rate, PER)and diastolic function(peak filling rate, PFR; Time to peak filling rate, TPFR)were determined by computer analysis of left ventricular time activity curve. Results: During dobutamine infusion in normal subjects, the left ventricular systolic and diastolic functions changed significantly from baseline to the dobutamine infusion rate at 20μg/kg/min(EF:59±6% to 69±7%,P＜0.05;PER:3.2±0.5 to 5.2±0.7 end-diastolic volumes/sec,P＜0.05;PFR:3.1±0.5 to 4.7±0.6 enddiastolic volumes/sec,P＜0.05;TPFR:140±30 to 100±36 msec,P＜0.05)The CAD patients, before PTCA, demonstrated left ventricular diastolic dysfunction(EF:56±4% to 63±6%,P＜0.05;PER:3.0±0.4 to 4.2±0.5 end-diastolic volumes/sec,P＜0.05;PFR:2.8±0.4to 2.6±0.6 end-diastolic volumes/sec,NS;TPFR:170±33 to 250±56 msec, P＜0.05).However, after successful PTCA, left ventricular functions response to dobutamine infusion were restored(EF:58±7% to 67±8%,P＜0.05;PER:3.1±0.5 to 4.5±0.4 end-diastolic volumes/sec, P＜0.05;PFR:3.0±0.5 to 4.3±0.5end-diastolic volumes/sec, P＜0.01;TPFR:151±50 to123±33 msec, P＜0.05)Conclusions: RNV is an easily performed and valuable method in the evaluation of the adrenergic effects on left ventricular functions in CAD patients before and after successful coronary angioplasty. Left ventricular diastolic dysfunction induced by dobutamine infusion can be restored by successful PTCA in coronary patients.

並列關鍵字

dobutamine ； coronary artery disease ； coro-nary angioplasty ； radionuclide ventricuiography