運動負荷による心筋梗塞患者の心機能の検討--心機図を中心として

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The systolic time intervals (STI) at rest show normal values several months after the infarction in most cases with myocardial infarction and do not differ significantly from those of normal control subjects. In order to see the difference between these two groups, the cardiac functions, especially the STI, after loading exercise were investigated in this study. The subjects employed were 33 patients who had relatively short intervals after the infarction (AMI group), 37 patients who have survived more than 6 months after the infarction (OMI group), and 24 normal control subjects. The exercise test was performed with a bicycle ergometer and the amount of load was 50 W for 5 minutes. The influence of the test with 75 W load was also investigated in the cases who well tolerated the test with 50 W load. The electrocardiogram, phonocardiogram, carotid pulse traching and blood pressure were recorded before, immediately after and every one minute untill 6 minutes after the test, and cardiac output was measured before, just after and 3 minutes after the test. Using these data, preejection period (PEP), ejection time (ET), electromechanical systole (QS2), PEP/ET ratio, heart rate (HR), mean blood pressure (MBP), Katz's Index (KI), cardiac index (CI) and stroke index (SI) were calculated. The differences between the data before and after the exercise test were also calculated and the revolution formulae based on the differences were obtained. The revolution formulae and the differences of the AMI-, OMI- and C group were compared at each time point of investigation. The difference between the groups with positive and negative exercise test, the differences between the tests with 50W and 75 W load, and the time course of the findings of the tests in an identical case were also investigated. No significant difference was observed among these three groups in the value of each parameter. The parameters with which the revolution formulae were introduced in these 3 groups were ΔPEPc, ΔPEP/ET ratio, ΔHR, ΔMBP, and ΔKI. The parameter increased temporarily from immediately after to 6 minutes after the exercise and the amounts of values were in the order of those in AMI-, OMI- and C group. Comparing the difference in the acute phase with those in the chronic phase in an identical cases, the difference of the latter was smaller than that of the former. The difference in the group with the positive exercise test was larger than that in the group with the negative test. ΔPEP/ET ratio was larger with 75 W load than with 50W load in OMI- and C group, while it was smaller with 75 W load than with 50 W load in AMI group. From these data, it was concluded that the difference after the exercise increased in the group with lower cardiac function by moderate exercise, that the difference tended to be small when the amount of load exceeds the physical work capacity, and, that PEP and PEP/ET ratio correlated well to CI and SI.
学校法人昭和大学・昭和医学会の論文

運動負荷による心筋梗塞患者の心機能の検討--心機図を中心として

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