定量心肌缺血的二维和多普勒超声心动图的实验研究
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摘要
七十年代后期，随着二维超声心动图(2DE)的临床应用，由于它能观察左室所有节段和检出局部室壁运动异常(RWMA)，在评价心肌缺血方面和梗塞取得了巨大的进展。2DE用途广泛，携带方便，是诊断和鉴别冠心病的理想技术之一。在临床和实验性冠脉阻塞后，2DE可定量评价RWMA和室壁厚度。现在，一些作者开始研究在负荷情况下的RWMA，如发现在运动试验中检出RWMA，而在静息情况下无RWMA。一般冠心病患者在无心肌梗塞时，于静息情况下可不出现室壁运动异常。实际上收缩期运动不正常可表现为暂时的或一过性的，如负荷诱发的心肌缺血。但是，冠脉流量(CBF)降低多少才有节段性左室功能障碍、局部左室收缩功能(RLVF)有明显改变或RLVF完全丧失，尚缺少研究。在不同程度心肌缺血时，2DE检测RLVF异常的敏感性和特异性也未完全定论。多数作者仅比较了人和动物心肌梗塞的大小及范围，发现室壁运动异常的范围与梗塞或缺血区的解剖大小相关较好。但多数室壁运动的分析方法趋向高估心肌梗塞的范围，其原因可能是梗塞周围邻近区域出现功能性异常(对这一点还有争议)，或与运动减弱区的机械性限制有关。另外，在心动周期中缺血区收缩期膨胀，室壁运动分析时可以人为地造成高估梗塞或缺血的范围。
评价心肌功能减低和缺血心肌的相互影响的关键是准确地定量分析RLVF。到目前为止，定量分析RWMA的方法，在短轴观主要包括测量从舒张末期至收缩末期的室壁增厚率，心内膜半轴和面积变化率。因此，这些方法依靠参考系统纠正心脏旋转和移动。现在认识到测量舒张功能对评价传统的收缩功能又补充了重要的信息，特别是多普勒超声心动图无创测定左室充盈。进一步研究的多普勒指标是峰值充盈率(PFR)，并且证明，PFR对于评定左室舒张功能和药理作用都非常有用。为了进一步证实急性心肌缺血时心脏功能的一系列病理生理学变化，本实验采用了定量心肌缺血的动物模型，探讨RLVF与心肌缺血时病理生理学变化的关系，如CBF、血液动力学变化和冠脉循环等。同时观察超声心动图负荷试验(EST)对定量缺血心脏的作用。实验动物为麻醉开胸犬，主要内容包括：
1．建立2DE定量分析RLVF的数学模型和计算方法。
2．寻找静息情况下2DE检出心肌缺血的阈值。
3．观察2DE定量检出心肌缺血的敏感性和特异性。
With the introduction of clinical two- dimensional echocardiography (2DE) in the late 1970s, the ability to visualize ail regions of left ventricle and to detect regional wall motion abnormalities ( RWMA) associated with myocardial ischemia or infarction was augmented tremendously. 2DE now offers an unparalleled view of left ventricular (LV) anatomy and provides a simultaneous assessment of endocardial wall motion and myocardial thickening. Its tremendous versatility, relatively low cost, portability, and high degree of accuracy, make it an ideal tool in experienced hands for evaluating patients with known or suspected coronary disease. The effects of complete coronary occlusion on cardiac wall thickening and RWMA have been quantitatively assessed by 2DE. Now some investigators have also begun to use 2DE to detect RWMA during stressful interventions such as'exercise when no abnormalities are apparent at rest. However, coronary artery disease (CAD) in the absence of myocardial infarction may not be associated with resting abnormalities. Indeed, contraction abnormalities may occur only transiently, such as during stress-induced ischemia. But, how much coronary blood flow (CBF) can be reduced without apparent RWMA of left ventricle, at what level of CBF reduction, the regional LV myocardial function (RLVF) is impaired
评价心肌功能减低和缺血心肌的相互影响的关键是准确地定量分析RLVF。到目前为止，定量分析RWMA的方法，在短轴观主要包括测量从舒张末期至收缩末期的室壁增厚率，心内膜半轴和面积变化率。因此，这些方法依靠参考系统纠正心脏旋转和移动。现在认识到测量舒张功能对评价传统的收缩功能又补充了重要的信息，特别是多普勒超声心动图无创测定左室充盈。进一步研究的多普勒指标是峰值充盈率(PFR)，并且证明，PFR对于评定左室舒张功能和药理作用都非常有用。为了进一步证实急性心肌缺血时心脏功能的一系列病理生理学变化，本实验采用了定量心肌缺血的动物模型，探讨RLVF与心肌缺血时病理生理学变化的关系，如CBF、血液动力学变化和冠脉循环等。同时观察超声心动图负荷试验(EST)对定量缺血心脏的作用。实验动物为麻醉开胸犬，主要内容包括：
1．建立2DE定量分析RLVF的数学模型和计算方法。
2．寻找静息情况下2DE检出心肌缺血的阈值。
3．观察2DE定量检出心肌缺血的敏感性和特异性。
With the introduction of clinical two- dimensional echocardiography (2DE) in the late 1970s, the ability to visualize ail regions of left ventricle and to detect regional wall motion abnormalities ( RWMA) associated with myocardial ischemia or infarction was augmented tremendously. 2DE now offers an unparalleled view of left ventricular (LV) anatomy and provides a simultaneous assessment of endocardial wall motion and myocardial thickening. Its tremendous versatility, relatively low cost, portability, and high degree of accuracy, make it an ideal tool in experienced hands for evaluating patients with known or suspected coronary disease. The effects of complete coronary occlusion on cardiac wall thickening and RWMA have been quantitatively assessed by 2DE. Now some investigators have also begun to use 2DE to detect RWMA during stressful interventions such as'exercise when no abnormalities are apparent at rest. However, coronary artery disease (CAD) in the absence of myocardial infarction may not be associated with resting abnormalities. Indeed, contraction abnormalities may occur only transiently, such as during stress-induced ischemia. But, how much coronary blood flow (CBF) can be reduced without apparent RWMA of left ventricle, at what level of CBF reduction, the regional LV myocardial function (RLVF) is impaired
引文
1．中华医学会。冠心病防治建议。中华心血管病杂志1987；313-135
2. Rosefield K, et al. Three-dimensional reconstruction of human coronary and peripheral from images recording during two-dimensional intravascular ultrasound examination. Circulation1991;84:1938
3. Reimer KA, et al. Pathobiology of acute myocardial ischemia metabolic, function and ultrastruetural studies. Am J cardiol 1983; 52:72A
4．陈士良等。冠心病领域研究的一些进展与展望(上)。心血管病学进展1992；13：65
5. Gould KL. Quantification of coronary artery stenosis in vivo.Cic Res 1985: 57:341
6. Topazo, et al. Complete left main coronary artery occlusion:Angiog1raphic evaluation of elaterd vessel patterns and assessment of heodynamie Correlates. Am Heart J 1991;121:450
7．苏哲坦。二维超声心动图在急性心肌梗塞的应用。心血管病译文1985；6：28
8. Heher JJ, et al, Cross-sectional echoeardiography in acute myocardial infarction: detection and localization of left ventricular asynergy Circulation 1979;60:531
9. Gillam LD, et al. A comparison of quantitative echocardiographic methods for delineating infarct-induced abnormal wall motion. Circulation 1984;113:70.
10. Gibson RS, et al. Value of early two dimension echocardiography in patients with acute myocardial infarction. Am J Cardiol 1982;49:110
11. Mann DL, et al. Cross-sectional echocardiographie assessment of regional left ventricular performance and myocardial perfusion. Prog in Cardiovas Dis 1986;29;1
12. Visser CA, et al. Detection and quantification of acute, isolated myocardial infarction by two dimensional echocardiography. Am J cardiol 1981;47:1020.
13.Horowitz Rs, et al. Immediate diagnosis of acute myocardial infarction by two-dimensional echocardiography. Circulation 1982; 65: 323
14. Aravn S, et al. Two-dimensional echocardiography versus surface electrodiography for diagnosis of acute non-Q wave myocardial infarction. Am Heart J 1985;110:44
15. Gregory R, et al. Value of two-dimensional echocardiography, electrocardiography, and clinical signs in detecting right ventricular infarction. Am Hear J 1986; 112: 304-309.
16. Visser CA, et al. Echocardiographic- cineangiographic correlation in detection left ventricular aneurysm; a prospective of 422 patients. Am J cardiol 1982; 50:337.
17. Saner HE, et al. Two- dimensional echocardiographic identification of left ventricular pseudoaneurysm. Am Heart J 1986, 112: 977.
18. Can G, et al. Short and long term predictive value of admission wall motion score in acute myocardial infarction A cross sectional echocardiographic study of 345 patients. Br Heart J 1986;56:422.
19. Kumar A, et al. Two- dimensional echocardiographic demonstration of restoration of normal wall motion after acute myocardial infarction. Am J Cardiol 1986; 57:1232.
20. Visser CA, et al. Incidence, Liming and prognostic value of left ventricular aneurysm formation after myocardial infarction;a prospective, serial echocardiographic study of 158 patients. Am J Cardiol 1986; 57: 729.
21. Miller TR, et al. Left ventricular diastolic filling and its association with age. Am J Cardiol 1986;58:531.
22. Iskandrian As, et al. Left ventricular diastolic function: evaluation by radionuclide angiography. Am Heart J 1988; 115: 924
23. Combelas I, et al, Echocardiographic features of impaired left ventricular diastolic function in Chaga's heart disease. Br Heart J 1985; 53: 298.
24. Brutsaert DL, et al. Analysis of relaxation in the evaluation of ventricular function of the heart. Prog in Cardiovasc Dis 1985;28:143
25．李汉康。左心室舒张功能研究的现状。国外医学心血管疾病分册。1990；17：88
26．苏哲坦等。左室舒张功能及其异常与治疗(上)心血管病学进展。1989；10：1
27．王彬等。多普勒超声心动图评定左室舒张功能。心血管病学进展。1988：9：34．
28. spirito P, et al. Noninvasive assessment of left ventricular diastolic function: comparative analysis of Doppler echocardiographic and radionuclide angiographic techniques. J Am coll cardiol 1986; 7:518.
29. Julius M, et al. Evaluation of dilated cardiomyopathy by pulsed Doppler echocardiography Am Heart J 1983; 106: 1057.
30. Spirto P, et al. Influence of aging on Doppler echocardiographic indices of LV diastolic function Br Heart J 1988;59: 672.
31. Jannet F, et al. Pulsed Doppler echoeardiographic determination of stroke volume and cardiac output: clinical validation of two new methods using the apical window. Circulation 1984; 70:425.
32. Rokey MD, et al. Determination of parameters of left Ventricular diastolic filling with pulsed Doppler echocardiography: Comparison with cineangiograpyhy. Circulation 1985;71: 543.
33. Bowman LK, et al. Peak filling rate normalized to mitral stroke volume: A new Doppler echocardiographic filling index validated by radionuclide angiographic techniques. J Am coll Cardiol. 1988;12(4): 1937.
34．侯家声。冠心病心功能早期异常超声研究进展。中国医学影像技术。1990；6：42
35. Lin SL, et al. Comparison of Doppler echocardiographic and hemodynamic indexes of LV diastolic properties in CAD. Am J Cardiol 1988;62:882.
36. Hirota Y: A clinical study of left ventricular relaxation. Circulation 1980;62:756.
37. Rousseau MF, et al. Relaxation between changes in left ventricular inotropie state and relaxation in normal subjects and patients with coronary artery disease. Circulation 1981;64:736-743
38. Dougherty AH, et al. Congestive heart failure with normal systolic function. Am J Cardiol 1984;64:778.
39. Topol EJ. et al. Hypertensive hypertrophic cardiomyopathy in the elderly. N Engl J Med 1985;312:277.
40. Sourer R, et al. Intact systolic left ventricular function in clinical congestive heart failure. Am J Cardiol 1984; 53:567-571.
41. Aroesty JM, et al. Simultaneous assessment of left ventricular systolic and diastolic dysfunction during pacing-induced ischemia.Circulation 1985;71:889.
42. Gilbert JC, Determinants of left ventricular filling and the diastolic pressure-volume relation. Cir Res 1989;64:827-852
43. Yellin EL, et al. Left ventricular filling dynamics and diastolic function. Prog Cardiovase Dis 1990;32:242.
44. Mirsky I, et al. Clinical assessment of diastolic function. Prog Cardiovase 1990;32:291.
45. Bonow RO, et al. Impaired diastolic filling in patients with coronary artery disease: Assessment with radionuclide angiography. Circulation 1981;64:315.
46. Magorien DJ, et al. Hemodynamic correlates for timing intervals, ejection rate and filling rate derived from the radionuclide angiographic volume curve. Am J Cardiol 1984; 53: 567.
47. Sanderson JE, et al. Left ventricular relaxation and filling in hypertrophic cardiomyopathy; An echocardiographic study. Br Heart J 1978; 40: 596.
48. Upton MT, et al. The study of left ventricular filling from digitized echocardiograms. Prog Cardiovasc Dis 1978;20:395.
49. Friedman, et al. Assessment of left ventricular diastolic function: comparison of Doppler echocardiography and gated pool scintigraphy. J Am Coll Cardiol 1986:8:1348.
50. Spirito P, et al. Noninvasive assessment of left ventricular diastolic function; comparative analysis of doppler echocardiographic and radionuclide angiographic techniques. J Am Coll Cardiol 1986;7:518.
51. Thomas JD, et al. Echocardiographic Doppler evaluation of left ventricular diastolic function. Circulation 1991; 84: 977.
52. Ilecito S, et al. Doppler echocardiographic evaluation of the effect of atrial pacing-induced ischemia on left ventricular filling in patients with coronary disease. J Am Coll Cardiol 1988;11:953 .
53. Klodenicki W, et al. Doppler evaluation of left ventricular filling dynamics during coronary angioplasty (abstract). J Am coll Cardiol 1987;9 (suppl A): 213A
54. Fujii, et al. Noninvasive assessment of left and right ventricular filling in myocardial infarction with a two -dimensional Doppler echocardiographic method. J Am Coll Cardiol 1985;56:921.
55. Snider AR. et al. Doppler evaluation of left ventricular diastolic filling in children with systemic hypertension. Am J Cardiol 1985;56:921.
56. Takenaka K, et al. Left ventricular filling in hypertrophic cardiomyopathy: a pulsed doppler echocardiographic study. J Am Coll Cardiol 1986; 7:1263.
57. Takenaka K, et al. Pulsed doppler echocardiographic study of left ventricular filling in dilated cardiomyopathy. Am J Cardiol 1986; 58:143.
58. Iwase M, et al. Effects of diltiazem on left ventricular diastolic behavior in patients with hypertrophic cardiomyopathy: Evaluation with exercise pulsed Doppler echocardiography. J Am Coll Cardiol 1987;9:1099.
59. Phillips RA, et al. Doppler echocardiographic analysis of left ventricular filling in treated hypertensive patients. J Am Coll Cardiol 1987; 9: 317.
60. Lee RT, et al. EffectB of nifedipine on transmitral doppler blood flow velocity profile in patients with concentric left ventricular hypertrophy. Am Heart J 1990;119:1130.
61. Choong CY, et al. Combined influence of ventricular loading and relaxation in the transmitral flow velocity profile in dogs measured by doppler echocardiography. Circulation 1988;78: 672.
62. Ishida Y, et al. Left ventricular filling dynamics: Influence of left ventricular relaxation and left atrial pressure. Circulation 1986;74:187-196
63. Stoddard MF, et al. Influence of alteration in preload on the pattern of Left ventricular diastolic filling as assessed by Doppler echocardiography in humans. Circulation 1989; 79 : 1226.
64. Gillam LD, et al. The influence of heart rate on doppler mitral inflow patterns (abstract). Circulation 1987;76 (suppl IV) : IV-123.
65. Harrison MR, et al. Effect of heart on Doppler indices of left ventricular diastolic filling in man (abstract). J Am Coll Cardiol 1990;15:164A
66. Parker TG, et al. The effect of heart rate and A-V interval on Doppler ultrasound indices of left ventricular diastolic function (abstract). Circulation 1987; 76 (supplⅣ): Ⅳ-124
67. Appleton CA, et al. Relation of transmitral flow velocity patterns to left ventricular diastolic function: New insights from a combined hemodynamic and Doppler echocardiographic study. J Am Coll Cardiol 1988;12:426-440
68. Davidson WR, et al. Doppler left ventricular filling pattern is closely related to ventricular relaxation abnormalities(abstract). J Am Coll Cardiol 1989;13:197A
69. Stoddard MF, et al. Left ventricular diastolic function: Comparison of pulsed doppler echocardiographic and hemodynamic indexes in subjects with and without coronary artery disease. J Am Coll Cardiol 1989;13:327.
70. Thomas JD, et al. Net left atrial and ventricular compliance can be derived from tansmitral velocity curves; A hydrodynamic in vitro study (abstract). J Am Coll Cardiol 1989; 13:198A
71. Flachskampf FA, et al. In vivo determination of net left ventricular compliance from mitral doppler profiles (abstract). Circulation 1990; 82 (suppl Ⅲ): Ⅲ-127
72. Weiss JL, et al. Hemodynamic determinants of the time-course of fall in canine left ventricular pressure. J Clin Invest 1976; 58:751.
73. Alexander JJ, et al. Instantaneous pressure-volume relation of the ejecting left atrium. Circ Res 1987;61:209.
74. Nishimura RA, et al. Relation of pulmonary vein to mitral flow velocities by transesophageal Doppler echocardiography: Effect of different Circulation 1990;81:1488.
75．周晓东等。心肌缺血与局部室壁运动异常。中国心功能杂志。1991；3：211
76. Maseri A:Pathogenetic mechanisms of angina pectoris: expanding views. Thomas Lewis lectures. Br Heart J 1980;43:648
77. Chierchia S, et al. Sequence of events in angina at rest: primary reduction of coronary flow. Circulation 1980; 61:759.
78. McAlpin RW: Relation coronary arterial spasm to sites of organic stenosis. Am J Cardiol 1980;46:143
79. Maseri A, Chierchia S: Coronary artery spasm: demonstration, definition, diagnosis and consequences. Prog Cardiovasc 1982; 25:169
80. Chierchia S, et al. Impairment of myocardial perfusion and function during painless myocardial ischemia. J Am Coll Cardiol 1983; 1: 924.
81. Epstein SE, et al. Dynamic coronary obstruction as a cause of angina pectoris: implications regarding therapy. AM J Cardiol 1985; 55: 61B,
82. Masdri A: role of coronary artery spasm in symptomatic and myocardial ischemia. J Am Coll Cardiol 1987; 9: 249.
83. Maseri A, et al. Coronary vasomotor tone: a heterogeneous entity. Eur Heart J 1989; 10(Suppl F):2
84. Collins P, Fox KM: Pathophysiology of angina. Lancet 1990;335:94.
85. Distante, et al. Pharmacological methods of exercise for the assessment of coronary artery disease. Echocardiography 1991;8:99.
86．施仲伟等。超声心动图运动试验诊断冠心病的研究概况。中华物理医学杂志。1985；7：187．
87. Presti CF, et al. Comparison of peak and post exercise echocardiographic imaging in evaluation of coronary artery disease (abstract). J Am Coll Cardiol 1987;9:217A.
88. Dymond DS, et al: Peak exercise and immediate post exercise imaging for the detection of left ventricular functional abnormalities in coronary artery disease. Am J Cardiol 1984;53:1532.
89．蒋锦琪等．二维超声心动图负荷或激发试验在诊断心病中的应用。中国医学影像技术。1989；5：44。
90. Chapman PD, et al. Stress echocardiography with transesophageal atrial pacing:preliminary report of a new method for detection of ischemic wall motion abnormalities Circulation. 1984;70:445.
91．解文等。冷加压试验多普勒超声心动图诊断冠心病的探讨。临床心血管病杂志．1988；4：105。
92. Holcoff RF, et al. Effect of the Cold pressor test on regional blood flow in patients with coronary artery disease. Am Heart J 1983; 106:78.
93. Cunnings MF, et al. the role of adrenal medullary catecholanime release in the response to a clod pressor test. Cardiovascular Research 1983; 17:189.
94. Buonanno C, et al. Effects of cold pressor test on the left ventricular function of patients with coronary disease. Int J Cardiol 1983; 3:295
95. Condi B, et al. Cold pressor test during two-dimensional echocardiography:usefulness in detection of patients with coronary artery disease. Am Heart J 1984; 107:278.
96. Nero a SB, et al. Quantitative Thallium-201 single photo emission computed tomography after oral dipyridamole for assessing the presence, anatomic location and severity coronary artery disease. J Am Coll Cardiol 1988;11:962.
97. Jain A et al. clinical significance of perfusion defects by Thallium-201 single photo emission tomography following oral dipyridamole early after coronary angioplasty. J Am Coll Cardiol 1988;11:970
98. Picano E, et al. Different degrees of ischemic threshold stratified by dipyridamole echocardiography test. Am J Cardiol 1987;59:71.
99. Picano E, et al. Transient myocardial dysfunction during pharmacological as an index of reduced coronary reserve; a coronary hemodynamic and echocardiographic study. J Am Coll Cardiol 1986;8:84.
100. Picano E,et al. Early post-infarction angina; usefulness of dipyridamole-echocardiography test. Eur Heart J 1986; 7 (Suppl. C): 55
101. Picano E, et al. Dipyridamole-echocardiography test in patients with exercise-induced ST segment elevation. Am J Cardiol 1986; 57: 765.
102．徐江等。腺苷的心脏作用。心血管病进展1991；12：6.
103.Verani Ms, et al. Diagnosis of Coronary artery disease by controlled coronary vasodilation with adenosine and thallium -201 scintigraphy in patients unable to exercise. Circulation 1990; 82: 80.
104.Meyer SL, et al: Influence of dobutamine on hemodynamics and coronary blood flow in patients with and without coronary artery disease. Am J Cardiol 1976;38:103.
105. Vasu MA, et al: Myocardial oxygen consumption: effects of epinephrine, isoproterenol, dopamine, norepinephrine and dobutamine. Am J Physiol 1978; 235:H237.
106. Berthe C, et al. Predicting the extent and location of coronary artery disease in acute myocardial infarction by echocardiography during dobutamine infusion. Am J Cardiol 1986;58:1167.
107. Mannering D, et al. the Dobutamine stress test as an altenative to exercise testing after acute myocardial Infarction. Br Heart J 1988;59:521.
108. Freeman ML, et al. A comparison of dobutamine infusion and supine bicycle exercise for radionuclide cardiac stress testing. Clin Nucl Med 1984;9:251.
109. Sawada SG, et al. Dobutamine stress echocardiography for evaluation of coronary artery disease. (Abstract) Circulation 1989;80(Ⅰ):66.
110. Wartlier DC, et al. Redistribution of myocardial blood flow distal to a dynamic coronary arterial stenosis by sympathomimetic amines. Comparison of dopamine, dobutamine and isoproterenol. Am J Cardiol 1981;48:269.
111. Bertrand ME, et al. Coronary arterial angiographic findings during transient myocardial ischemia. Can J Cardiol 1986; 2 (SupplA):205.
112. Previtali M, et al. Hyperventilation and ergonovine tests in prinz-metal's variant angina pectoris in Man. Am J Cardiol 1989;63:17.
113. Bauman D, et al. Complications after provocation of coronary spasm ergonovine maleate. Am J Cardiol 1987;42:694.
114. Waters DD, et al. Ergonovine testing in a coronary care unit environment. Am J Cardiol 1980;46:922.
115. Distante A, et al. Coronary vasospasm: provocative ergonovine testing during echocardiographic monitoring. In Kerber RE(ed):Echocardiography in coronary artery disease. Mt Kiseo, New York, Futura Publishing Co, Inc, 1988, p.165.
116. Picano E et al. Aminophylline termination of coronary vasospasm in variant angina. Am J Cardiol 1988;62:694.
117．沈跃华，等．二维超声心动图左室部室壁运动分析法。中华物理医学杂 志。1989；11：50．
118. Vatner SF. Correlation between acute reductions in myocardial blood flow and Function in conscious dogs. Cir Res 1980; 47 201.
119. Tennant R, et al. The effect of coronary occlusion on myocardial contraction. Am J physiol 1935;112:351.
120. Swan HJC. Mechanical Function of the heart and its alteration during myocardial ischemia and infarction. Circulation 1979;60: 1587
121．陈士良，等。冠脉狭窄对心功能的影响。中国病理生理学杂志1988；4：276．
122. Gould KL. Quantification of coronary artery stenosis in vivo. Circ Res 1985;57:341.
123. Macus ML. The coronary circulation in health and disease. 1983; P95-152. McGraw-Hill Book Company New york.
124. wiesel J, et al. Quantitation of absolute area of a coronary artery stenosis: experimental validation with a preparation in vivo. Circulation 1986;74:1089-1106
125. Nichols AB, et al. Effect of coronary stenosis on regional myocardial blood flow at rest. Circulation 1986;746-757
126．孙建中，等。犬冠状动脉阻力的胆碱能调节。生理学报1985；37：578。1987：3：43
127. Logan SE. On the fluid mechanisms of human coronary stenosis.IEEE Trans Biomed Eng 1975;22:327.
128. Mancini GBJ, et al. Relation between graded, subcritical impairments of coronary flow reserve and regional myocardial dysfunction induced by isoproterenol infusion in dogs. Am Heart J 1987;113:906.
129．周晓东，等．二维超声心动图定量分析局部左室收缩功能的计算方法。中华物理学杂志。1991；13：19．
130. Zoghbi WA, et al. End-systolic radius to thickness ratio: an echocardiographic index of regional performance during reversible myocardial ischemia in the conscious dog. J Am Coll Cardiol 1987;10: 113
131. Wyatt HL, et al. Cross-sectional echocardiography Ⅰ. analysis of mathematic models for quantifying mass of the left ventricle in dogs. Circulation 1979; 60;1104
132．张运编。多普勒超声心动图学 青岛出版社。1989．9第一版，P180-183．
133. William A, et al. Assessment of left ventricular diastolic filling by two-dimensional echocardiography. Am Heart J 1987;113: 1108.
134. Braverman AC, et al. Doppler echocardiographic estimation of mitral valve during changing hemodynamie conditions. Am J Cardiol 1991; 68: 1486.
136. Falsetti HL, et al. Left ventricular wall stress calculated from one plane cineangiography. Cire Res 1970; 26: 71.
136. Quinones MA, et al. Noninvasive determination of the left ventrieular wall stress. Am J Cardiol 1980;46:782.
137. Wilson JR, et al. Noninvasive assessment of load reduction in patients with asymptomatic aortic regurgitation. Am J Med 1980; 68: 664.
138. Depaee NL, et al. Correlation of eehocardiographic wall stress and left ventrieular pressure and function in aortic stenosis. Circulation 1983; 67: 854.
139．中国药理学报编辑部。投搞须知，中国药理学报，1988；9：1
140. Tennant R, et al. The effect of coronary occlusion on myocardial contraction. Am J Physiol 1935; 112: 351.
141．代瑞鸿主编《心肌梗塞》。上海科学技术出版社，第一版1987，4。
142. Hoffman JIE, et al: Pathophysiology of supendoeardial isehemia. Br med J. 1(6949):76,1976
143. conetta DA, et al. Echoeardiographie analysis of systolic and diastolic Left ventricular wall motion during transient myocardial ischemia. J chin ultrasound 1981;9:59.
144. Robert AK, et al. Observation on experimental myocardial ischemia. Cardiovascular Res.1980;14:371.
145. pandian NG, et al: Two-dimensional echocardiography in experimental coronary stenosis. Circulation 66:597,1982.
146. Heger JJ, et al:Cross-sectional echocardiographic analysis of the extent of left ventricular asynergy in acute myocardial infarction. Circulation 61:1113, 1980.
147. Felix Z, et al. the quantitative assessment of coronary artery dimensions predict the physiological significance of a coronary stenosis? Circulation 1987;75:1154.
148．周晓东等。二维超声心动图定量检测心肌缺血的实验研究——定量心肌缺血与局部左室收缩功能的关系。中国心功能杂志。1991；3：1。
149. Guth BD, et al. Decreased systolic wall thickening in myocardium adjacent to ischemic zones in conscious swine during brief coronary artery occlusions. Am Heart J 1984;107:458.
150. Buda AJ, et al. Comparison of two-dimensional echocardiography wall motion and wall thickening abnormalities in relation to the myocardium at risk. Am Heart J 1986;111:587.
151. Roger WJ, et al. Effect of projection and interobserver variability on angiographic biplane left ventricular volume determination. Circulation 1979;59:96.
152. Parist AF, et al. Quantitative detection of regional left ventricular contraction abnormalities by two-dimensional echocardiography Ⅱ, accuracy in coronary artery disease. Circulation 1981;63:761.
153. Moynihan PF, et al. Quantitative detection of regional left ventricular contraction abnormalities by two-dimensional echocardiography Ⅰ, analysis of methods. Circulation 1981; 63：752．
154．李云霞．心肌力学和心肌收缩性能的评定 生理科学进展 1980；11(3)：212．
155. Ilictos. et al. Doppler echocardiographic evaluation of the effect of atrial pacing-induced ischemia on left ventricular filling in patients with coronary artery disease. J Am Coll Cardiol. 1988;11:953.
156. Willam A, et al. Assessment of left ventricular diastolic filling by two-dimensional echocardiography. Am Heart J 1987;113:1103.
157. Ross J. Mechanisms of regional ischemia and antianginal drug action during exercise, prog in Cardiovas Dis 1989;31:455
158．彭章平，等．潘生丁试验的现状．心血管病学进展1991；12：110
2. Rosefield K, et al. Three-dimensional reconstruction of human coronary and peripheral from images recording during two-dimensional intravascular ultrasound examination. Circulation1991;84:1938
3. Reimer KA, et al. Pathobiology of acute myocardial ischemia metabolic, function and ultrastruetural studies. Am J cardiol 1983; 52:72A
4．陈士良等。冠心病领域研究的一些进展与展望(上)。心血管病学进展1992；13：65
5. Gould KL. Quantification of coronary artery stenosis in vivo.Cic Res 1985: 57:341
6. Topazo, et al. Complete left main coronary artery occlusion:Angiog1raphic evaluation of elaterd vessel patterns and assessment of heodynamie Correlates. Am Heart J 1991;121:450
7．苏哲坦。二维超声心动图在急性心肌梗塞的应用。心血管病译文1985；6：28
8. Heher JJ, et al, Cross-sectional echoeardiography in acute myocardial infarction: detection and localization of left ventricular asynergy Circulation 1979;60:531
9. Gillam LD, et al. A comparison of quantitative echocardiographic methods for delineating infarct-induced abnormal wall motion. Circulation 1984;113:70.
10. Gibson RS, et al. Value of early two dimension echocardiography in patients with acute myocardial infarction. Am J Cardiol 1982;49:110
11. Mann DL, et al. Cross-sectional echocardiographie assessment of regional left ventricular performance and myocardial perfusion. Prog in Cardiovas Dis 1986;29;1
12. Visser CA, et al. Detection and quantification of acute, isolated myocardial infarction by two dimensional echocardiography. Am J cardiol 1981;47:1020.
13.Horowitz Rs, et al. Immediate diagnosis of acute myocardial infarction by two-dimensional echocardiography. Circulation 1982; 65: 323
14. Aravn S, et al. Two-dimensional echocardiography versus surface electrodiography for diagnosis of acute non-Q wave myocardial infarction. Am Heart J 1985;110:44
15. Gregory R, et al. Value of two-dimensional echocardiography, electrocardiography, and clinical signs in detecting right ventricular infarction. Am Hear J 1986; 112: 304-309.
16. Visser CA, et al. Echocardiographic- cineangiographic correlation in detection left ventricular aneurysm; a prospective of 422 patients. Am J cardiol 1982; 50:337.
17. Saner HE, et al. Two- dimensional echocardiographic identification of left ventricular pseudoaneurysm. Am Heart J 1986, 112: 977.
18. Can G, et al. Short and long term predictive value of admission wall motion score in acute myocardial infarction A cross sectional echocardiographic study of 345 patients. Br Heart J 1986;56:422.
19. Kumar A, et al. Two- dimensional echocardiographic demonstration of restoration of normal wall motion after acute myocardial infarction. Am J Cardiol 1986; 57:1232.
20. Visser CA, et al. Incidence, Liming and prognostic value of left ventricular aneurysm formation after myocardial infarction;a prospective, serial echocardiographic study of 158 patients. Am J Cardiol 1986; 57: 729.
21. Miller TR, et al. Left ventricular diastolic filling and its association with age. Am J Cardiol 1986;58:531.
22. Iskandrian As, et al. Left ventricular diastolic function: evaluation by radionuclide angiography. Am Heart J 1988; 115: 924
23. Combelas I, et al, Echocardiographic features of impaired left ventricular diastolic function in Chaga's heart disease. Br Heart J 1985; 53: 298.
24. Brutsaert DL, et al. Analysis of relaxation in the evaluation of ventricular function of the heart. Prog in Cardiovasc Dis 1985;28:143
25．李汉康。左心室舒张功能研究的现状。国外医学心血管疾病分册。1990；17：88
26．苏哲坦等。左室舒张功能及其异常与治疗(上)心血管病学进展。1989；10：1
27．王彬等。多普勒超声心动图评定左室舒张功能。心血管病学进展。1988：9：34．
28. spirito P, et al. Noninvasive assessment of left ventricular diastolic function: comparative analysis of Doppler echocardiographic and radionuclide angiographic techniques. J Am coll cardiol 1986; 7:518.
29. Julius M, et al. Evaluation of dilated cardiomyopathy by pulsed Doppler echocardiography Am Heart J 1983; 106: 1057.
30. Spirto P, et al. Influence of aging on Doppler echocardiographic indices of LV diastolic function Br Heart J 1988;59: 672.
31. Jannet F, et al. Pulsed Doppler echoeardiographic determination of stroke volume and cardiac output: clinical validation of two new methods using the apical window. Circulation 1984; 70:425.
32. Rokey MD, et al. Determination of parameters of left Ventricular diastolic filling with pulsed Doppler echocardiography: Comparison with cineangiograpyhy. Circulation 1985;71: 543.
33. Bowman LK, et al. Peak filling rate normalized to mitral stroke volume: A new Doppler echocardiographic filling index validated by radionuclide angiographic techniques. J Am coll Cardiol. 1988;12(4): 1937.
34．侯家声。冠心病心功能早期异常超声研究进展。中国医学影像技术。1990；6：42
35. Lin SL, et al. Comparison of Doppler echocardiographic and hemodynamic indexes of LV diastolic properties in CAD. Am J Cardiol 1988;62:882.
36. Hirota Y: A clinical study of left ventricular relaxation. Circulation 1980;62:756.
37. Rousseau MF, et al. Relaxation between changes in left ventricular inotropie state and relaxation in normal subjects and patients with coronary artery disease. Circulation 1981;64:736-743
38. Dougherty AH, et al. Congestive heart failure with normal systolic function. Am J Cardiol 1984;64:778.
39. Topol EJ. et al. Hypertensive hypertrophic cardiomyopathy in the elderly. N Engl J Med 1985;312:277.
40. Sourer R, et al. Intact systolic left ventricular function in clinical congestive heart failure. Am J Cardiol 1984; 53:567-571.
41. Aroesty JM, et al. Simultaneous assessment of left ventricular systolic and diastolic dysfunction during pacing-induced ischemia.Circulation 1985;71:889.
42. Gilbert JC, Determinants of left ventricular filling and the diastolic pressure-volume relation. Cir Res 1989;64:827-852
43. Yellin EL, et al. Left ventricular filling dynamics and diastolic function. Prog Cardiovase Dis 1990;32:242.
44. Mirsky I, et al. Clinical assessment of diastolic function. Prog Cardiovase 1990;32:291.
45. Bonow RO, et al. Impaired diastolic filling in patients with coronary artery disease: Assessment with radionuclide angiography. Circulation 1981;64:315.
46. Magorien DJ, et al. Hemodynamic correlates for timing intervals, ejection rate and filling rate derived from the radionuclide angiographic volume curve. Am J Cardiol 1984; 53: 567.
47. Sanderson JE, et al. Left ventricular relaxation and filling in hypertrophic cardiomyopathy; An echocardiographic study. Br Heart J 1978; 40: 596.
48. Upton MT, et al. The study of left ventricular filling from digitized echocardiograms. Prog Cardiovasc Dis 1978;20:395.
49. Friedman, et al. Assessment of left ventricular diastolic function: comparison of Doppler echocardiography and gated pool scintigraphy. J Am Coll Cardiol 1986:8:1348.
50. Spirito P, et al. Noninvasive assessment of left ventricular diastolic function; comparative analysis of doppler echocardiographic and radionuclide angiographic techniques. J Am Coll Cardiol 1986;7:518.
51. Thomas JD, et al. Echocardiographic Doppler evaluation of left ventricular diastolic function. Circulation 1991; 84: 977.
52. Ilecito S, et al. Doppler echocardiographic evaluation of the effect of atrial pacing-induced ischemia on left ventricular filling in patients with coronary disease. J Am Coll Cardiol 1988;11:953 .
53. Klodenicki W, et al. Doppler evaluation of left ventricular filling dynamics during coronary angioplasty (abstract). J Am coll Cardiol 1987;9 (suppl A): 213A
54. Fujii, et al. Noninvasive assessment of left and right ventricular filling in myocardial infarction with a two -dimensional Doppler echocardiographic method. J Am Coll Cardiol 1985;56:921.
55. Snider AR. et al. Doppler evaluation of left ventricular diastolic filling in children with systemic hypertension. Am J Cardiol 1985;56:921.
56. Takenaka K, et al. Left ventricular filling in hypertrophic cardiomyopathy: a pulsed doppler echocardiographic study. J Am Coll Cardiol 1986; 7:1263.
57. Takenaka K, et al. Pulsed doppler echocardiographic study of left ventricular filling in dilated cardiomyopathy. Am J Cardiol 1986; 58:143.
58. Iwase M, et al. Effects of diltiazem on left ventricular diastolic behavior in patients with hypertrophic cardiomyopathy: Evaluation with exercise pulsed Doppler echocardiography. J Am Coll Cardiol 1987;9:1099.
59. Phillips RA, et al. Doppler echocardiographic analysis of left ventricular filling in treated hypertensive patients. J Am Coll Cardiol 1987; 9: 317.
60. Lee RT, et al. EffectB of nifedipine on transmitral doppler blood flow velocity profile in patients with concentric left ventricular hypertrophy. Am Heart J 1990;119:1130.
61. Choong CY, et al. Combined influence of ventricular loading and relaxation in the transmitral flow velocity profile in dogs measured by doppler echocardiography. Circulation 1988;78: 672.
62. Ishida Y, et al. Left ventricular filling dynamics: Influence of left ventricular relaxation and left atrial pressure. Circulation 1986;74:187-196
63. Stoddard MF, et al. Influence of alteration in preload on the pattern of Left ventricular diastolic filling as assessed by Doppler echocardiography in humans. Circulation 1989; 79 : 1226.
64. Gillam LD, et al. The influence of heart rate on doppler mitral inflow patterns (abstract). Circulation 1987;76 (suppl IV) : IV-123.
65. Harrison MR, et al. Effect of heart on Doppler indices of left ventricular diastolic filling in man (abstract). J Am Coll Cardiol 1990;15:164A
66. Parker TG, et al. The effect of heart rate and A-V interval on Doppler ultrasound indices of left ventricular diastolic function (abstract). Circulation 1987; 76 (supplⅣ): Ⅳ-124
67. Appleton CA, et al. Relation of transmitral flow velocity patterns to left ventricular diastolic function: New insights from a combined hemodynamic and Doppler echocardiographic study. J Am Coll Cardiol 1988;12:426-440
68. Davidson WR, et al. Doppler left ventricular filling pattern is closely related to ventricular relaxation abnormalities(abstract). J Am Coll Cardiol 1989;13:197A
69. Stoddard MF, et al. Left ventricular diastolic function: Comparison of pulsed doppler echocardiographic and hemodynamic indexes in subjects with and without coronary artery disease. J Am Coll Cardiol 1989;13:327.
70. Thomas JD, et al. Net left atrial and ventricular compliance can be derived from tansmitral velocity curves; A hydrodynamic in vitro study (abstract). J Am Coll Cardiol 1989; 13:198A
71. Flachskampf FA, et al. In vivo determination of net left ventricular compliance from mitral doppler profiles (abstract). Circulation 1990; 82 (suppl Ⅲ): Ⅲ-127
72. Weiss JL, et al. Hemodynamic determinants of the time-course of fall in canine left ventricular pressure. J Clin Invest 1976; 58:751.
73. Alexander JJ, et al. Instantaneous pressure-volume relation of the ejecting left atrium. Circ Res 1987;61:209.
74. Nishimura RA, et al. Relation of pulmonary vein to mitral flow velocities by transesophageal Doppler echocardiography: Effect of different Circulation 1990;81:1488.
75．周晓东等。心肌缺血与局部室壁运动异常。中国心功能杂志。1991；3：211
76. Maseri A:Pathogenetic mechanisms of angina pectoris: expanding views. Thomas Lewis lectures. Br Heart J 1980;43:648
77. Chierchia S, et al. Sequence of events in angina at rest: primary reduction of coronary flow. Circulation 1980; 61:759.
78. McAlpin RW: Relation coronary arterial spasm to sites of organic stenosis. Am J Cardiol 1980;46:143
79. Maseri A, Chierchia S: Coronary artery spasm: demonstration, definition, diagnosis and consequences. Prog Cardiovasc 1982; 25:169
80. Chierchia S, et al. Impairment of myocardial perfusion and function during painless myocardial ischemia. J Am Coll Cardiol 1983; 1: 924.
81. Epstein SE, et al. Dynamic coronary obstruction as a cause of angina pectoris: implications regarding therapy. AM J Cardiol 1985; 55: 61B,
82. Masdri A: role of coronary artery spasm in symptomatic and myocardial ischemia. J Am Coll Cardiol 1987; 9: 249.
83. Maseri A, et al. Coronary vasomotor tone: a heterogeneous entity. Eur Heart J 1989; 10(Suppl F):2
84. Collins P, Fox KM: Pathophysiology of angina. Lancet 1990;335:94.
85. Distante, et al. Pharmacological methods of exercise for the assessment of coronary artery disease. Echocardiography 1991;8:99.
86．施仲伟等。超声心动图运动试验诊断冠心病的研究概况。中华物理医学杂志。1985；7：187．
87. Presti CF, et al. Comparison of peak and post exercise echocardiographic imaging in evaluation of coronary artery disease (abstract). J Am Coll Cardiol 1987;9:217A.
88. Dymond DS, et al: Peak exercise and immediate post exercise imaging for the detection of left ventricular functional abnormalities in coronary artery disease. Am J Cardiol 1984;53:1532.
89．蒋锦琪等．二维超声心动图负荷或激发试验在诊断心病中的应用。中国医学影像技术。1989；5：44。
90. Chapman PD, et al. Stress echocardiography with transesophageal atrial pacing:preliminary report of a new method for detection of ischemic wall motion abnormalities Circulation. 1984;70:445.
91．解文等。冷加压试验多普勒超声心动图诊断冠心病的探讨。临床心血管病杂志．1988；4：105。
92. Holcoff RF, et al. Effect of the Cold pressor test on regional blood flow in patients with coronary artery disease. Am Heart J 1983; 106:78.
93. Cunnings MF, et al. the role of adrenal medullary catecholanime release in the response to a clod pressor test. Cardiovascular Research 1983; 17:189.
94. Buonanno C, et al. Effects of cold pressor test on the left ventricular function of patients with coronary disease. Int J Cardiol 1983; 3:295
95. Condi B, et al. Cold pressor test during two-dimensional echocardiography:usefulness in detection of patients with coronary artery disease. Am Heart J 1984; 107:278.
96. Nero a SB, et al. Quantitative Thallium-201 single photo emission computed tomography after oral dipyridamole for assessing the presence, anatomic location and severity coronary artery disease. J Am Coll Cardiol 1988;11:962.
97. Jain A et al. clinical significance of perfusion defects by Thallium-201 single photo emission tomography following oral dipyridamole early after coronary angioplasty. J Am Coll Cardiol 1988;11:970
98. Picano E, et al. Different degrees of ischemic threshold stratified by dipyridamole echocardiography test. Am J Cardiol 1987;59:71.
99. Picano E, et al. Transient myocardial dysfunction during pharmacological as an index of reduced coronary reserve; a coronary hemodynamic and echocardiographic study. J Am Coll Cardiol 1986;8:84.
100. Picano E,et al. Early post-infarction angina; usefulness of dipyridamole-echocardiography test. Eur Heart J 1986; 7 (Suppl. C): 55
101. Picano E, et al. Dipyridamole-echocardiography test in patients with exercise-induced ST segment elevation. Am J Cardiol 1986; 57: 765.
102．徐江等。腺苷的心脏作用。心血管病进展1991；12：6.
103.Verani Ms, et al. Diagnosis of Coronary artery disease by controlled coronary vasodilation with adenosine and thallium -201 scintigraphy in patients unable to exercise. Circulation 1990; 82: 80.
104.Meyer SL, et al: Influence of dobutamine on hemodynamics and coronary blood flow in patients with and without coronary artery disease. Am J Cardiol 1976;38:103.
105. Vasu MA, et al: Myocardial oxygen consumption: effects of epinephrine, isoproterenol, dopamine, norepinephrine and dobutamine. Am J Physiol 1978; 235:H237.
106. Berthe C, et al. Predicting the extent and location of coronary artery disease in acute myocardial infarction by echocardiography during dobutamine infusion. Am J Cardiol 1986;58:1167.
107. Mannering D, et al. the Dobutamine stress test as an altenative to exercise testing after acute myocardial Infarction. Br Heart J 1988;59:521.
108. Freeman ML, et al. A comparison of dobutamine infusion and supine bicycle exercise for radionuclide cardiac stress testing. Clin Nucl Med 1984;9:251.
109. Sawada SG, et al. Dobutamine stress echocardiography for evaluation of coronary artery disease. (Abstract) Circulation 1989;80(Ⅰ):66.
110. Wartlier DC, et al. Redistribution of myocardial blood flow distal to a dynamic coronary arterial stenosis by sympathomimetic amines. Comparison of dopamine, dobutamine and isoproterenol. Am J Cardiol 1981;48:269.
111. Bertrand ME, et al. Coronary arterial angiographic findings during transient myocardial ischemia. Can J Cardiol 1986; 2 (SupplA):205.
112. Previtali M, et al. Hyperventilation and ergonovine tests in prinz-metal's variant angina pectoris in Man. Am J Cardiol 1989;63:17.
113. Bauman D, et al. Complications after provocation of coronary spasm ergonovine maleate. Am J Cardiol 1987;42:694.
114. Waters DD, et al. Ergonovine testing in a coronary care unit environment. Am J Cardiol 1980;46:922.
115. Distante A, et al. Coronary vasospasm: provocative ergonovine testing during echocardiographic monitoring. In Kerber RE(ed):Echocardiography in coronary artery disease. Mt Kiseo, New York, Futura Publishing Co, Inc, 1988, p.165.
116. Picano E et al. Aminophylline termination of coronary vasospasm in variant angina. Am J Cardiol 1988;62:694.
117．沈跃华，等．二维超声心动图左室部室壁运动分析法。中华物理医学杂 志。1989；11：50．
118. Vatner SF. Correlation between acute reductions in myocardial blood flow and Function in conscious dogs. Cir Res 1980; 47 201.
119. Tennant R, et al. The effect of coronary occlusion on myocardial contraction. Am J physiol 1935;112:351.
120. Swan HJC. Mechanical Function of the heart and its alteration during myocardial ischemia and infarction. Circulation 1979;60: 1587
121．陈士良，等。冠脉狭窄对心功能的影响。中国病理生理学杂志1988；4：276．
122. Gould KL. Quantification of coronary artery stenosis in vivo. Circ Res 1985;57:341.
123. Macus ML. The coronary circulation in health and disease. 1983; P95-152. McGraw-Hill Book Company New york.
124. wiesel J, et al. Quantitation of absolute area of a coronary artery stenosis: experimental validation with a preparation in vivo. Circulation 1986;74:1089-1106
125. Nichols AB, et al. Effect of coronary stenosis on regional myocardial blood flow at rest. Circulation 1986;746-757
126．孙建中，等。犬冠状动脉阻力的胆碱能调节。生理学报1985；37：578。1987：3：43
127. Logan SE. On the fluid mechanisms of human coronary stenosis.IEEE Trans Biomed Eng 1975;22:327.
128. Mancini GBJ, et al. Relation between graded, subcritical impairments of coronary flow reserve and regional myocardial dysfunction induced by isoproterenol infusion in dogs. Am Heart J 1987;113:906.
129．周晓东，等．二维超声心动图定量分析局部左室收缩功能的计算方法。中华物理学杂志。1991；13：19．
130. Zoghbi WA, et al. End-systolic radius to thickness ratio: an echocardiographic index of regional performance during reversible myocardial ischemia in the conscious dog. J Am Coll Cardiol 1987;10: 113
131. Wyatt HL, et al. Cross-sectional echocardiography Ⅰ. analysis of mathematic models for quantifying mass of the left ventricle in dogs. Circulation 1979; 60;1104
132．张运编。多普勒超声心动图学 青岛出版社。1989．9第一版，P180-183．
133. William A, et al. Assessment of left ventricular diastolic filling by two-dimensional echocardiography. Am Heart J 1987;113: 1108.
134. Braverman AC, et al. Doppler echocardiographic estimation of mitral valve during changing hemodynamie conditions. Am J Cardiol 1991; 68: 1486.
136. Falsetti HL, et al. Left ventricular wall stress calculated from one plane cineangiography. Cire Res 1970; 26: 71.
136. Quinones MA, et al. Noninvasive determination of the left ventrieular wall stress. Am J Cardiol 1980;46:782.
137. Wilson JR, et al. Noninvasive assessment of load reduction in patients with asymptomatic aortic regurgitation. Am J Med 1980; 68: 664.
138. Depaee NL, et al. Correlation of eehocardiographic wall stress and left ventrieular pressure and function in aortic stenosis. Circulation 1983; 67: 854.
139．中国药理学报编辑部。投搞须知，中国药理学报，1988；9：1
140. Tennant R, et al. The effect of coronary occlusion on myocardial contraction. Am J Physiol 1935; 112: 351.
141．代瑞鸿主编《心肌梗塞》。上海科学技术出版社，第一版1987，4。
142. Hoffman JIE, et al: Pathophysiology of supendoeardial isehemia. Br med J. 1(6949):76,1976
143. conetta DA, et al. Echoeardiographie analysis of systolic and diastolic Left ventricular wall motion during transient myocardial ischemia. J chin ultrasound 1981;9:59.
144. Robert AK, et al. Observation on experimental myocardial ischemia. Cardiovascular Res.1980;14:371.
145. pandian NG, et al: Two-dimensional echocardiography in experimental coronary stenosis. Circulation 66:597,1982.
146. Heger JJ, et al:Cross-sectional echocardiographic analysis of the extent of left ventricular asynergy in acute myocardial infarction. Circulation 61:1113, 1980.
147. Felix Z, et al. the quantitative assessment of coronary artery dimensions predict the physiological significance of a coronary stenosis? Circulation 1987;75:1154.
148．周晓东等。二维超声心动图定量检测心肌缺血的实验研究——定量心肌缺血与局部左室收缩功能的关系。中国心功能杂志。1991；3：1。
149. Guth BD, et al. Decreased systolic wall thickening in myocardium adjacent to ischemic zones in conscious swine during brief coronary artery occlusions. Am Heart J 1984;107:458.
150. Buda AJ, et al. Comparison of two-dimensional echocardiography wall motion and wall thickening abnormalities in relation to the myocardium at risk. Am Heart J 1986;111:587.
151. Roger WJ, et al. Effect of projection and interobserver variability on angiographic biplane left ventricular volume determination. Circulation 1979;59:96.
152. Parist AF, et al. Quantitative detection of regional left ventricular contraction abnormalities by two-dimensional echocardiography Ⅱ, accuracy in coronary artery disease. Circulation 1981;63:761.
153. Moynihan PF, et al. Quantitative detection of regional left ventricular contraction abnormalities by two-dimensional echocardiography Ⅰ, analysis of methods. Circulation 1981; 63：752．
154．李云霞．心肌力学和心肌收缩性能的评定 生理科学进展 1980；11(3)：212．
155. Ilictos. et al. Doppler echocardiographic evaluation of the effect of atrial pacing-induced ischemia on left ventricular filling in patients with coronary artery disease. J Am Coll Cardiol. 1988;11:953.
156. Willam A, et al. Assessment of left ventricular diastolic filling by two-dimensional echocardiography. Am Heart J 1987;113:1103.
157. Ross J. Mechanisms of regional ischemia and antianginal drug action during exercise, prog in Cardiovas Dis 1989;31:455
158．彭章平，等．潘生丁试验的现状．心血管病学进展1991；12：110