Chanson P, Megnien J L, del Pino M, Coirault C, Merli I, Houdouin L, Harris A G, Levenson J, Lecarpentier Y, Simon A, Chemla D
Service d'Endocrinologie et des Maladies de la Reproduction, Centre Hospitalier Universitaire de Bicêtre.
Clin Endocrinol (Oxf). 1998 Dec;49(6):725-31. doi: 10.1046/j.1365-2265.1998.00620.x.
One-third of acromegalic patients have hypertension. Acromegaly is also associated with intrinsic cardiac abnormalities known collectively as a hyperkinetic heart syndrome, which is characterized by an increased cardiac index and decreased systemic vascular resistance. As a result, blood flow should be increased in the regional vascular beds of acromegalic patients. The aim of the study was to measure, using direct methods, blood flow and vascular resistance at the level of the brachial artery in acromegalic patients with a confirmed hyperkinetic heart syndrome.
Twelve patients with active acromegaly (five females, seven males; mean (+/- SD) age, 43 +/- 10 years) were studied. Twelve age- and sex-matched normal subjects served as controls.
Right heart catheterization was used to measure the cardiac index and stroke volume and to calculate systemic vascular resistance in the acromegalic patients. Brachial haemodynamics were evaluated with a two-dimensional pulsed Doppler system (double transducer probe and range-gated time system of reception). The mean diameter of the brachial artery and mean blood velocity were measured and used to calculate mean blood flow. Vascular resistance was calculated in the brachial artery as the mean arterial pressure/blood flow ratio.
Age, body weight, height, body surface area and heart rate were similar in the acromegalic patients and controls, while mean arterial pressure was higher in patients. The cardiac index and stroke volume were increased in the acromegalic patients, at 4.08 +/- 0.47 (mean +/- SD) l/min/m2 body surface area and 116.7 +/- 19.4 ml, respectively, while systemic vascular resistance was low (12.5 +/- 2.1 U). Brachial artery diameter was similar in the patients and controls. Brachial artery mean blood velocity (P < 0.01) and mean blood flow (P < 0.05) were lower in the patients than in the controls (3.35 +/- 1.26 vs. 5.12 +/- 1.74 cm/s, and 16.4 +/- 9.4 vs. 25.6 +/- 11.6 ml/min/m2, respectively). The higher mean arterial pressure and lower mean blood flow resulted in higher forearm vascular resistance in the patients than in the controls (132 +/- 61 vs. 83.8 +/- 47 mmHg/ml/s/m2, respectively, P < 0.01).
While cardiac output is increased and systemic vascular resistance is decreased in active acromegaly, direct measurement of brachial artery haemodynamics showed lower regional blood flow and increased local resistance relative to healthy controls. These results suggest a heterogeneous distribution of cardiac output in acromegaly.
三分之一的肢端肥大症患者患有高血压。肢端肥大症还与统称为高动力心脏综合征的内在心脏异常有关，其特征是心脏指数增加和全身血管阻力降低。因此，肢端肥大症患者局部血管床的血流量应增加。本研究的目的是使用直接方法测量确诊为高动力心脏综合征的肢端肥大症患者肱动脉水平的血流量和血管阻力。
研究了12例活动性肢端肥大症患者（5名女性，7名男性；平均（±标准差）年龄，43±10岁）。12名年龄和性别匹配的正常受试者作为对照。
对肢端肥大症患者进行右心导管检查，以测量心脏指数和每搏量，并计算全身血管阻力。使用二维脉冲多普勒系统（双换能器探头和距离选通时间接收系统）评估肱动脉血流动力学。测量肱动脉的平均直径和平均血流速度，并用于计算平均血流量。肱动脉的血管阻力计算为平均动脉压/血流量比值。
肢端肥大症患者和对照组的年龄、体重、身高、体表面积和心率相似，但患者的平均动脉压较高。肢端肥大症患者的心脏指数和每搏量增加，分别为4.08±0.47（平均±标准差）升/分钟/平方米体表面积和116.7±19.4毫升，而全身血管阻力较低（12.5±2.1单位）。患者和对照组的肱动脉直径相似。患者的肱动脉平均血流速度（P<0.01）和平均血流量（P<0.05）低于对照组（分别为3.35±1.26与5.12±1.74厘米/秒，以及16.4±9.4与25.6±11.6毫升/分钟/平方米）。较高的平均动脉压和较低的平均血流量导致患者的前臂血管阻力高于对照组（分别为132±61与83.8±47毫米汞柱/毫升/秒/平方米，P<0.01）。
虽然活动性肢端肥大症患者的心输出量增加且全身血管阻力降低，但肱动脉血流动力学的直接测量显示，相对于健康对照组，局部血流量较低且局部阻力增加。这些结果表明肢端肥大症患者的心输出量分布不均。
