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1.
Nicolò Pecorelli Giovanni Capretti Gianpaolo Balzano Renato Castoldi Marianna Maspero Luigi Beretta Marco Braga 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(3):270-278
Background
Enhanced recovery (ER) pathways have improved outcomes across multiple surgical specialties, but reports concerning their application in distal pancreatectomy (DP) are lacking. The aim of this study was to assess compliance with an ER protocol and its impact on short-term outcomes in patients undergoing DP.Methods
Prospectively collected data were reviewed. One hundred consecutive patients undergoing DP were treated within an ER pathway comprising 18 care elements. Each patient was matched 1:1 with a patient treated with usual perioperative care. Match criteria were age, BMI, ASA score, lesion site, and type of disease.Results
Adherence to ER items ranged from 15% for intraoperative restrictive fluids to 100% for intraoperative warming, antibiotic and anti-thrombotic prophylaxis. Patients in ER group experienced earlier recovery of gastrointestinal function (2 vs. 3 days, p < 0.001), oral intake (2 vs. 4 days, p < 0.001), and suspension of intravenous infusions (3 vs. 5 days, p < 0.001). Overall morbidity was similar in the two groups (72% vs. 78%). Length of hospital stay (LOS) was reduced in ER patients without postoperative complications (6.7 ± 1.2 vs. 7.6 ± 1.6 days, p = 0.041).Conclusions
An ER pathway for DP yielded an earlier postoperative recovery and shortened LOS in uneventful patients. Postoperative morbidity and readmissions were similar in both groups. 相似文献2.
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Stefano Partelli Roberto Cirocchi Paola M.V. Rancoita Francesca Muffatti Valentina Andreasi Stefano Crippa Domenico Tamburrino Massimo Falconi 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2018,20(3):197-203
Background
Role of palliative pancreatic neuroendocrine neoplasm (PanNEN) resection (pPanNEN-R) is controversial. This study was designed as a meta-analysis of studies which allow a comparison of pPanNEN-R and non-surgical management (PanNEN-nR).Methods
All published studies until 2017 allowing for the comparison of pPanNEN-R and PanNEN-nR were reviewed. Primary outcome was overall survival (OS). Secondary outcomes measures included postoperative morbidity, reoperation, readmission, length of hospital stay (LOS), and quality of life (QoL). Risk of death was compared by computing the odds-ratio (OR), while 5- and 10-year OS using weighted mean differences.Results
Seven studies were included. A total of 885 patients were included, of whom 252 (28%) underwent pPanNEN-R and 633 (72%) underwent PanNEN-nR. Overall quality of included studies was fair. The risk of death was significantly reduced in patients who underwent pPanNEN-R compared to those who underwent PanNEN-nR (OR = 0.38, 95% CI 0.23–0.65). Data on postoperative morbidity, reoperation, readmission, LOS, and QoL were not adequately reported therefore a meta-analysis for the secondary outcomes was not performed.Discussion
pPanNEN-R in patients with unresectable LM seems to be associated with a better OS compared to non-surgical management but the limitations of included studies does not allow firm conclusions. 相似文献4.
Lorenzo Azzalini Soledad Ojeda Ozan M. Demir Joseph Dens Masaki Tanabe Alessio La Manna Susanna Benincasa Barbara Bellini Enrico Poletti Davide Maccagni Francisco Hidalgo Jorge Chavarría Joren Maeremans Giacomo Gravina Eligio Miccichè Guido D’Agosta Giuseppe Venuti Corrado Tamburino Antonio Colombo 《The Canadian journal of cardiology》2018,34(10):1275-1282
Background
Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is associated with high contrast volumes, which can be particularly deleterious in patients with chronic kidney disease (CKD). We aimed to study the outcomes of CTO PCI in subjects with vs without CKD, and the impact of contrast-induced acute kidney injury (CI-AKI).Methods
This multicentre registry included patients who underwent CTO PCI at 5 centres. CI-AKI was defined as an increase in serum creatinine ≥0.3 mg/dL or ≥50% from baseline within 72 hours. Study endpoints were CI-AKI, and all-cause death and target-lesion failure (TLF: cardiac death, target-vessel myocardial infarction, or target-lesion revascularization) on follow-up.Results
Study population included 1092 patients (CKD n = 214, no CKD n = 878). Patients with CKD had more comorbidities and adverse angiographic features, compared with subjects without CKD. Patients with CKD experienced lower technical (79% vs 87%, P = 0.001) and procedural (79% vs 86%, P = 0.008) success rates. CI-AKI developed in 9.1% (CKD 15.0% vs no CKD 7.8%, P = 0.001). Rates of in-hospital need for dialysis were 0.5% vs 0%, respectively (P = 0.03). Patients with CKD had higher 24-month rates of all-cause death (11.2% vs 2.7%, P < 0.001) and new need for dialysis (1.1% vs 0.1%, P = 0.03), but similar TLF rates (12.4% vs 10.5%, P = 0.47). CI-AKI was not an independent predictor of all-cause death or TLF.Conclusions
CTO PCI in patients with CKD is associated with lower success rates and higher incidence of CI-AKI. The need for dialysis both in-hospital and on follow-up is infrequent. Although patients with CKD suffer higher rates of all-cause death, TLF rates are similar regardless of CKD status. 相似文献5.
Alberto Mariani Simone Segato Andrea Anderloni Gianpaolo Cengia Marco Parravicini Teresa Staiano Gian Eugenio Tontini Davide Lochis Paolo Cantù Guido Manfredi Arnaldo Amato Stefano Bargiggia Giordano Bernasconi Fausto Lella Marcella Berni Canani Paolo Beretta Luca Ferraris Sergio Signorelli Germana de Nucci 《Digestive and liver disease》2019,51(7):978-984
BackgroundProspective studies about endoscopic retrograde cholangio-pancreatography (ERCP) in a community setting are rare.AimTo assess success and complication rates of routinely-performed ERCP in a regional setting, and the priority quality indicators for ERCP practice.MethodsProspective region wide observational study on consecutive patients undergoing ERCP during a 6-month period. A centralized online ERCP questionnaire was built and used for data storage. Primary quality indicators provided by the American Society of Gastrointestinal Endoscopy (ASGE) were considered.Results38 endoscopists from 18 centers performed a total of 2388 ERCP. The most common indication for ERCP was choledocholitiasis (54.8%) followed by malignant jaundice (22.6%). Cannulation of the desired duct was obtained in 2293 cases (96%) and ERCP was successful in 2176 cases (91.1%). Success and ERCP difficulty were significantly related to the experience of the operator (p = 0.001 and p < 0.001, respectively). ERCP difficulty was also significantly related to volume centers (p < 0.01). The overall complication rate was 8.4%: post-ERCP pancreatitis (PEP) occurred in 4.1% of procedures, bleeding in 2.9%, infection in 0.8%, perforation in 0.4%. Mortality rate was 0.4%. All the ASGE priority quality indicators for ERCP were confirmed.ConclusionsThe procedural questionnaire proved to be an important tool to assess and verify the quality of routinely-performed ERCP performance in a community setting. 相似文献
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Daisuke Hokuto Takeo Nomi Satoshi Yasuda Chihiro Kawaguchi Takahiro Yoshikawa Kohei Ishioka Shinsaku Obara Takatsugu Yamada Hiromichi Kanehiro 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(4):359-364
Background
Prophylactic drainage after liver resection remains a common practice amongst hepatic surgeons. However, there is little information about the optimal timing of drain removal.Methods
From April 2008 to December 2012 (conventional group), the drains were removed based on the treating surgeon's view. From January 2013 to April 2016 (ERP group), the drains were removed on POD 3 if the bile concentration of the drain discharge was less than three times the serum bilirubin on POD 3, and the amount of drain discharge was <500 ml on POD 3. The postoperative outcomes of the two groups were compared using one-to-one propensity score-matching analysis.Results
One hundred nine patients were extracted from ERP group (n = 226) and conventional group (n = 246). The time to drain removal was significantly shorter in the ERP group than in the conventional group (3 days vs. 5 days, P < 0.001). The frequency of delayed bile leakage or the appearance of symptomatic abdominal fluid collection after drain removal did not differ between the two groups (3% vs. 4%, P = 0.791).Conclusion
Drain removal on POD 3 based on the volume and bile concentration is safe. 相似文献9.
Paschalis Gavriilidis Ernest Hidalgo Nicola de&#x;Angelis Peter Lodge Daniel Azoulay 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(1):16-20
Aim
The benefit of prophylactic drainage after uncomplicated hepatectomy remains controversial. The aim of this study was to update the existing evidence on the role of prophylactic drainage following uncomplicated liver resection.Methods
Cochrane, Medline (Pubmed), and Embase were searched. The Medline search strategy was adopted for all other databases. A grey literature search was performed. Meta-analyses were performed with Review Manager 5.3. Primary outcomes were mortality and ascitic leak, secondary outcomes were infected intra-abdominal collection, chest infection, wound infection of the surgical incision, biliary fistula, and length of stay.Results
The incidence of ascitic leak was higher in the drained group (Odds Ratio = 3.33 [95% Confidence Interval: 1.66–5.28]). Infected intra-abdominal collections, wound infections, chest infections, biliary fistula, length of stay and mortality were not statistically different between groups.Conclusions
The routine utilisation of drains after elective uncomplicated liver resection does not translate into a lower incidence of postoperative complications. Therefore, based on the current available evidence, routine abdominal drainage is not recommended in elective uncomplicated hepatectomy. 相似文献10.
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Safi Dokmak Béatrice Aussilhou Fanjandrainy Rasoaherinomenjanahary Maxime Ronot Rafik Dahdouh Fadhel S. Ftériche François Cauchy Valérie Paradis Jacques Belghiti Olivier Soubrane 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2018,20(12):1198-1205
Background
Hemorrhage is the main complication of hepatocellular adenoma (HCA). The aim of this study was to describe a single center's evolving management of patients with hemorrhagic HCA.Method
Between 1990 and 2013, all patients with hemorrhagic HCA were included. During the study period, the management evolved from urgent surgery (period <2004) to arterial embolization with (period, 2004–2010) or without (period > 2010) delayed resection.Results
A total of 56 patients were identified. The median (range) size of HCA and the hematoma was 80 mm (35–160) and 50 mm (10–160). Patients were treated by urgent resection (group 1, n = 6), delayed resection with or without embolization (group 2, n = 43) and systematic embolization without surgery (group 3, n = 7). Embolization was performed in 0/6, 15/43 and 7/7 in groups 1, 2 and 3. Urgent resection was associated with higher morbidity (p < 0.001). Complete necrosis was observed in 0/6, 13/43 and 3/7 patients, and on histology it was associated with embolization (p = 0.001), a hematoma-tumor ratio > 60% (p = 0.046) and a cystic non-viable lesion before surgery (p < 0.001).Conclusion
Hemodynamic stability can be achieved in patients presenting with hemorrhagic HCA by none surgical means. Subsequent surgery can be completely avoided with such an approach in up to 40% of patients. 相似文献12.
Nastassja Köhn Johannes Maubach Rene Warschkow Catherine Tsai Daniel P. Nussbaum Daniel Candinas Beat Gloor Bruno M. Schmied Dan G. Blazer Mathias Worni 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2018,20(11):1073-1081
Background
Current consensus guidelines suggest that gallbladder cancer (GBC) patients with resected T1a disease can be observed while patients with T1b or greater lesions should undergo lymphadenectomy (LNE). The primary aim of this study was to critically explore the impact of LNE in early-stage GBC on overall survival (OS) on a population-based level.Method
The 2004–2014 National Cancer Database was reviewed to identify non-metastatic GBC patients with T1a, T1b, or T2 disease and grouped whether a dedicated LNE was performed. OS and relative survival were assessed using Cox proportional hazard regression analyses before and after propensity score adjustments.Results
4015 patients were included, 246 (6%) had T1a, 654 (16%) T1b, and 3115 (78%) T2 GBC. The rate of positive lymph nodes was 13%, 12%, and 40% for T1a, T1b, and T2 tumors, respectively. Even after propensity score adjustment, no OS benefit was found if LNE was performed for T1a disease (HR:0.63, 95%CI:0.35–1.13) while OS was improved for T1b (HR:0.65, 95%CI:0.49–0.87) and T2 tumors (HR:0.65, 95%CI:0.57–0.73).Conclusion
Despite a higher rate of nodal positivity among patients with T1a disease compared to previous reports, there was no impact on survival and current treatment guidelines appear appropriate for the management of T1a disease. 相似文献13.
Background
The July 2014 war in Gaza caused more devastation in the area than at any time since the Israeli occupation began in 1967. The 50-day war resulted in more than 2200 Palestinian deaths, over 11?000 injuries, and large-scale destruction of infrastructure and displacement of over a quarter of the Palestinian population in Gaza. In this study, we examined the causal effect of damage to buildings within a neighbourhood on displacement behaviour in Gaza. Identifying demographic and socioeconomic predictors of displacement, given ongoing exposure to chronic violence and precarious living conditions in Gaza, will allow for action to be taken to avert the consequences of modifiable risk factors of displacement in this population.Methods
The study was based on data from a 2015 cross-sectional survey including a representative sample of households in the occupied Palestinian territory. The study sample included 10?017 Gazans aged 18 years and above from whom complete data were available for 9285 adults, who were included in matching analysis. Through a quasi-experimental design, propensity score matching estimators were used to evaluate causality between exposure and outcome. The exposure effect was whether 5% or more of the buildings in a respondent's neighbourhood experienced damage. The outcome variable was self-reported displacement from residence as a result of the war. Score matching was conducted using age, sex, education, marital status, refugee status, Gaza residence, employment, household age composition, household crowding (≥3 people per room, excluding kitchen and bathrooms), income, injury status, chronic disease status, and car possession status.Findings
Of the 9285 adults in the analysis, 5304 (57·12%) reported displacement and 3005 (32·36%) lived in an area that experienced damage to buildings during the war. Being a refugee in Gaza and having higher levels of educational attainment were found to be protective against experiencing displacement. An analysis of model-based estimates and average treatment effect showed a positive effect of neighbourhood damage on displacement (average treatment effect 0·35; 95% CI 0·33–0·36), indicating that living in an area that experienced damaged due to war caused displacement.Interpretation
Damage to buildings had a substantial impact on population displacement during the 2014 Israel–Gaza conflict, but was not the sole predictor of displacement. The substantial proportion of individuals who were displaced did not live in areas that experienced damage directly, indicating that they were potentially influenced by perception of danger and fear in general. A limitation of this study is the possibility that not all relevant covariates in the matching stage are accounted for, which would reduce comparability of treatments and control groups, and thus limit assertions of causality. Findings from this study can be used to help inform public health programmes and policies designed to protect and serve displaced civilian populations during humanitarian emergencies such as wars, in Gaza and beyond.Funding
This project was supported, in part, by a research grant from the Yale MacMillan Center for International and Area Studies, and an award from the Yale Center for the Study of Race, Indigeneity, and Transnational Migration. 相似文献14.
Charing C.N. Chong Kit-Fai Lee Cheuk-Man Chu Anthony W.H. Chan John Wong Stephen L. Chan Hon-Ting Lok Andrew K.Y. Fung Anthony K.W. Fong Yue S. Cheung Simon C.H. Yu Philip Johnson Paul B.S. Lai 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2018,20(6):546-554
Background
Studies comparing microwave ablation (MWA) and liver resection are lacking. This study evaluates the survival of patients with hepatocellular carcinoma (HCC) treated with liver resection or MWA and the role of Albumin-Bilirubin (ALBI) score in patient selection for treatments.Methods
This is a retrospective analysis of patients who received curative liver resection or MWA for HCC. Propensity score matching was used at a 1:1 ratio. The value of ALBI grade for patient selection was evaluated. Overall and disease-free survival were compared between two groups.Results
Of the 442 patients underwent MWA or liver resection for HCC during the study period, 63 patients received MWA and 379 patients received liver resection. Propensity scoring matching analysis resulted in 63 matched pairs for further analysis. Subgroup analysis according to the ALBI grade was performed. Liver resection offered better overall and disease-free survivals in patients with ALBI grade 1. MWA provided a significantly better overall survival (p = 0.025) and a trend towards better disease-free survival (p = 0.39) in patients with ALBI grade 2 or 3.Conclusions
Liver resection offered superior disease-free survival to MWA in patients with HCC. The ALBI grade could identify patients with worse liver function who might gain survival advantage from MWA. 相似文献15.
Amanda P.C.S. Boteon Yuri L. Boteon James Hodson Helen Osborne John Isaac Ravi Marudanayagam Darius F. Mirza Paolo Muiesan John K. Roberts Robert P. Sutcliffe 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2019,21(1):26-33
Background
Unplanned hospital readmission after pancreaticoduodenectomy (PD) is usually due to surgical complications and has significant clinical and economic impact. This study developed a risk score to predict 30-day readmission after PD.Methods
Patients undergoing PD between 2009 and 2016 were reviewed from a prospective database. Predictors of readmission were identified using a multivariable logistic regression model, from which a points-based risk scoring system was derived.Results
81 of 518 patients (15.6%) were readmitted within 30 days. History of cardiac disease ([odds ratio] OR = 2.12; 95% CI: 1.12–4.56), CRP>140 mg/L on post-operative day 3 (OR = 2.34; 95% CI: 1.37–4.35) and comprehensive complication index >14 (OR = 1.74; 95% CI: 1.03–2.85) were independent predictors of readmission. The regression coefficients were used to generate a risk score with excellent calibration (p = 0.917) and good discrimination (c-index = 0.65; 95% CI: 0.58–0.71; p < 0.001). Patients were categorised as low, moderate and high risk, with readmission rates of 6.4%, 13.4% and 23.0% respectively (p < 0.001).Conclusion
The risk score identifies patients at high risk of readmission after pancreaticoduodenectomy. Such patients may benefit from pre-discharge imaging and/or enhanced follow-up, which may potentially reduce the impact of readmissions. 相似文献16.
Ruo-fan Sheng Li Yang Kai-pu Jin He-qing Wang Hao Liu Yuan Ji Cai-xia Fu Meng-su Zeng 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2018,20(4):305-312
Background
To investigate the diagnostic value of diffusion kurtosis imaging (DKI) and diffusion-weighted imaging (DWI) in assessing liver regeneration after associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) compared with portal vein ligation (PVL).Methods
Thirty rats were divided into the ALPPS, PVL, and control groups. DKI and DWI were performed before and 7 days after surgery. Corrected apparent diffusion (D), kurtosis (K) and apparent diffusion coefficient (ADC) were calculated and compared, radiologic–pathologic correlations were evaluated.Results
The volume of the right median lobe increased significantly after ALPPS. There were larger cellular diameters after ALPPS and PVL (P = 0.0003). The proliferative indexes of Ki-67 and hepatocyte growth factor were higher after ALPPS (P = 0.0024/0.0433). D, K and ADC values differed between the groups (P = 0.021/0.0015/0.0008). A significant correlation existed between D and the hepatocyte size (r = ?0.523), no correlations existed in ADC and K (P = 0.159/0.111). The proliferative indexes showed moderate negative correlations with ADC (r = ?0.484/?0.537) and no correlations with D and K (P = 0.100–0.877).Discussion
Liver regeneration after ALPPS was effective and superior to PVL. DKI, especially the D map, may provide added value in evaluating the microstructure of liver regeneration after ALPPS, but this model alone may perform no better than the standard monoexponential model of DWI. 相似文献17.
Chetana Lim Chady Salloum Francesco Esposito Alexandros Giakoustidis Toufic Moussallem Michael Osseis Eylon Lahat Marc Lanteri-Minet Daniel Azoulay 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2018,20(9):823-828
Background
Elective liver resection (LR) in Jehovah’s Witness (JW) patients, for whom transfusion is not an option, involves complex ethical and medical issues and surgical difficulties.Methods
Consecutive data from a LR program for liver tumors in JWs performed between 2014 and 2017 were retrospectively reviewed. A systematic review of the literature with a pooled analysis was performed.Results
Ten patients were included (median age = 61 years). None needed preoperative erythropoietin. Tumor biopsy was not performed. Major hepatectomy was performed in 4 patients. The median estimated blood loss was 200 mL. A cell-saver was installed in 2 patients, none received saved blood. The median hemoglobin values before and at the end of surgery were 13.4 g/dL and 12.6 g/dL, respectively (p = 0.04). Nine complications occurred in 4 patients, but no postoperative hemorrhage occurred. In-hospital mortality was nil. Nine studies including 35 patients were identified in the literature; there was reported no mortality and low morbidity. None of the patients were transfused.Conclusions
By using a variety of blood conservation techniques, the risk/benefit ratio of elective liver resection for liver was maintained in selected adult JW patients. JW faith should not constitute an absolute exclusion from hepatectomy. 相似文献18.
Weidong Xiao Jisheng Zhu Long Peng Le Hong Gen Sun Yong Li 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2018,20(10):896-904
Background
The aim of this systematic review and meta-analysis was to compare the clinical outcomes of central pancreatectomy (CP) with distal pancreatectomy (DP) and pancreaticoduodenectomy (PD).Methods
A systematic literature research in PubMed/Medline, Embase and Cochrane Library was performed to identify articles reporting CP from January 1983 to November 2017.Results
Fifty studies with 1305 patients undergoing CP were identified. The overall morbidity, mortality, pancreatic fistula (PF) rate and reoperation rate was 51%, 0.5%, 35% and 4% respectively. Endocrine and exocrine insufficiency were occurred in 4% and 5% of patients after CP. Meta-analysis of CP versus DP favored CP with regard to less blood loss (WMD = ?143.4, P = 0.001), lower rates of endocrine (OR = 0.13, P < 0.001) and exocrine insufficiency (OR = 0.38, P < 0.001). CP was associated with higher morbidity and PF rate. In comparison with PD, CP had a lower risk of endocrine (OR = 0.14, P < 0.001) and exocrine insufficiency (OR = 0.14, P < 0.001), but a higher PF rate (OR = 1.6, P = 0.015).Conclusions
CP maintains pancreatic endocrine and exocrine function better than DP and PD, but is associated with a higher PF rate. 相似文献19.
Sean Bennett Laura K. Baker Guillaume Martel Risa Shorr Timothy M. Pawlik Alan Tinmouth Daniel I. McIsaac Paul C. Hébert Paul J. Karanicolas Lauralyn McIntyre Alexis F. Turgeon Jeffrey Barkun Dean Fergusson 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(4):321-330
Background
Liver resection is associated with a high proportion of red blood cell transfusions. There is a proposed association between perioperative transfusions and increased risk of complications and tumor recurrence. This study reviews the evidence of this association in the literature.Methods
The Medline, EMBASE, and Cochrane databases were searched for clinical trials or observational studies of patients undergoing liver resection that compared patients who did and did not receive a perioperative red blood cell transfusion. Outcomes were mortality, complications, and cancer survival.Results
Twenty-two studies involving 6832 patients were included. All studies were retrospective, with no clinical trials. No studies were scored as low risk of bias. The overall proportion of patients transfused was 38.3%. After multivariate analysis, 1 of 5 studies demonstrated an association between transfusion and increased mortality; 5 of 6 demonstrated an association between transfusion and increased complications; and 10 of 18 demonstrated an association between transfusion and decreased cancer survival.Conclusion
This review supports the evidence linking perioperative blood transfusions to negative outcomes. The most convincing association was with post-operative complications, some association with long-term cancer outcomes, and no convincing association with mortality. These findings support the initiation, and further study, of restrictive transfusion protocols. 相似文献20.
Robert Slutsky MD Guy Curtis MD Alexander Battler MD Victor Froelicher MD FACC John Ross Jr. MD FACC Donald Gordon MD FACC William Ashburn MD Joel Karliner MD FACC 《The American journal of cardiology》1979,44(7):1365-1370
Left ventricular function and size were assessed with equilibrium radionuclide angiography at rest and after administration of 0.6 mg of sublingual nitroglycerin in 12 patients with a history of previous myocardial infarction. Spontaneous angina developed in five patients and seven patients had no pain at the time of study. Sequential ejection fractions and end-diastolic and end-systolic volumes were developed by summing multiple R-R intervals to produce a composite time-activity curve. Volumes were calculated with a nongeometric method that utilizes counts at end-diastole and end-systole and is corrected for total heartbeats and plasma radioactivity. In the patients without acute ischemia, peak increase in ejection fraction occurred 6 to 8 minutes after ingestion of nitroglycerin and was associated with an equal decrease in end-diastolic and end-systolic volumes with no change in stroke volume. End-diastolic and end-systolic volumes, stroke volume, heart rate and systolic blood pressure all returned to baseline levels by 1 hour after nitroglycerin. In the patients with spontaneous angina, ejection fraction and stroke volume decreased before pain occurred. End-diastolic volume increased slightly (7 percent), but end-systolic volume increased markedly (38 percent), thus explaining the decrease in stroke volume. After nitroglycerin, end-diastolic volume and end-systolic volume and systolic blood pressure decreased and stroke volume and ejection fraction increased. Improvement in function occurred before relief of pain.
It is concluded that the action of nitroglycerin on the left ventricle in patients without acute ischemia is to increase ejection fraction by an equal decrease in end-diastolic and end-systolic volumes with little change in stroke volume. A reduction in left ventricular function during acute ischemia precedes complaints of pain and is associated with an increase in end-systolic and end-diastolic volumes and a decrease in ejection fraction and stroke volume. In these patients, nitroglycerin appeared to contribute to relief of pain by decreasing end-diastolic volume and systolic blood pressure. 相似文献