心配糖体治療における電気的心室収縮時間と機械的心室収縮時間の問題
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概要
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42 subjects with congestive heart failure who had the complete sinus rhythm and no intraventricular conduction disturbance were treated with cardiac glycosides. Bpth electrical (QT) and mechanical (QII) systole-lengths of the ventricles were measured and compared before and after the recompensation. On the other hand, cardiovascular dynamical analysis as well as x-ray kymography was simultaneously examined. QTr was often pathologically prolonged in the patients with cardiac insufficiency, coronary disease, aortic and combined valvular diseases ; it was found 109% on an average. Whereas QTr of the group with mitral valvular disorders remained as a rule within normal range. QIIr appeared to change also nearly in the same way as QTr did, however in the coronary disease the prolongation of QTr was marked, whereas that of QIIr was slight. By the cardiac glycoside therapy both QTr and QIIr were diminished in the most of cases, and there existed only one patient whose QTr and QIIr.conversely changed. Generally speaking, the rate of the change in QTr was longer than that in QIIr. In order to examine the direction of the changes in QTr and QIIr due to the therapy, when QTr is taken in ordinante and QIIr in abscissa respectively, then the mean gradient of both sorts of changes was found the steepest in coronary disordrs, that is, 73°, next 54° in hypertensive heart disease, then 52° in aortic as well as combined valvular diseases and 48° in mitral valvular disease. Thus the mean gradient of the changes in QTr and QIIr differed from the kinds of disorders. By the treatment QTr in the aortic valvular disease was not often sufficiently reduced, but QTr as well as QIIr in the hypertensive heart disease was used to be significantly diminished. Apart from the fact that the constituent elements of heart diseases vary with advance of age, the rate of the change in QTr became more striking than that in QIIr by the glycoside therapy. In the juvenile group the rate of the change in QIIr was more marked than that in QTr, however the gradient of both changes remained still gently-sloping. In 30 or 40 years of age the gradient of both changes became steeper, i. e. the mean gradient of the changes was 45°, and in 50 years of age the rate of the change in QTr exceeded that in QIIr and the gradient became steeper, that is, showed 64°. Over 60 years of age the gradient became again gently sloping, that is, showed 47°. The digitalis refractoriness was found in two among 27 patients who were treated for the first time with cardiac glycosides. In these two subjects QIIr was prolonged despite of the diminution of QTr, the one patient of them showed the dysproteinemia and the another suffered from the coronary heart disease. The number of subjects who showed the dissociated direction of changes in QTr rnd QIIr was not always pararell to the frequency of decompensation, 50.2% of total patients showed the increase in cardiac output more than 15% by the therapy. There could not be confirmed any certainty between the extent of the change in cardiac output and that in QTr as wellas QIIr. The cardiac glycoside therapy diminished the cardiac surface in 41% of total observation. In the patients who showed QTr more than 103% at the decompensated stage the cardiac surface was reduced or remained unchanged, i. e., at least did not increase, whereas in the patients who showed QTr less than 100% before the therapy the cardiac surface occasionally increased in its area.
- 千葉大学の論文
- 1962-11-28