Mehta J, Pepine C J
Circulation. 1978 Nov;58(5):803-7. doi: 10.1161/01.cir.58.5.803.
We evaluated the effects of sublingual nitroglycerin on indices of regional coronary flow and coronary resistance (CR) in 12 selected patients with coronary artery disease (CAD) and eight with normal coronary arteries (NCA), using continuous thermodilution. Resting total left ventricular flow, reflected by coronary sinus flow (CSF), and anterior regional flow, reflected by great cardiac vein flow (GCVF), in NCA and CAD patient groups, were similar. However, in a subgroup of six patients, with CAD limited to the anterior descending artery, GCVF was lower and anterior regional CR (CRANT) higher than the NCA subjects. Nitroglycerin reduced the systolic pressure-heart rate product similarly in both patient groups. CSF and GCVF in NCA subjects declined 15% and 17%, respectively, as total CR (CRT) and CRANT increased. In the CAD subgroup, consisting of patients with CAD limited to the anterior descending, GCVF increased 48% as CRANT declined 50%, and CSF was unchanged. In the other CAD subgroup of patients with CAD in the right and/or circumflex arteries, GCVF declined 32% and CRANT increased 46% as CSF was minimally increased. These data imply that sublingual nitroglycerin reduces both CSF and GCVF in NCA patients as oxygen demands decrease. In certain CAD patients, however, nitroglycerin alters regional coronary venous blood flow, suggesting a redistribution of flow from normally perfused to hypoperfused regions.
我们采用连续热稀释法，评估了舌下含服硝酸甘油对12例选定的冠状动脉疾病（CAD）患者和8例冠状动脉正常（NCA）患者的局部冠状动脉血流和冠状动脉阻力（CR）指标的影响。在NCA和CAD患者组中，由冠状窦血流（CSF）反映的静息左心室总血流量以及由大心静脉血流（GCVF）反映的前壁局部血流量相似。然而，在6例CAD局限于前降支动脉的患者亚组中，GCVF低于NCA受试者，且前壁局部CR（CRANT）高于NCA受试者。硝酸甘油在两组患者中使收缩压与心率乘积下降的幅度相似。在NCA受试者中，随着总CR（CRT）和CRANT升高，CSF和GCVF分别下降了15%和17%。在由CAD局限于前降支的患者组成的CAD亚组中，随着CRANT下降50%，GCVF增加了48%，而CSF未改变。在右冠状动脉和/或回旋支动脉患有CAD的另一CAD亚组患者中，随着CSF略有增加，GCVF下降了32%，CRANT增加了46%。这些数据表明，在NCA患者中，随着氧需求降低，舌下含服硝酸甘油会使CSF和GCVF均降低。然而，在某些CAD患者中，硝酸甘油会改变局部冠状静脉血流，提示血流从正常灌注区域重新分布至灌注不足区域。
