缺血性心脏病患者侧支循环依赖心肌中冠状动脉“窃血”与静息收缩功能之间的关系。

Relation between coronary "steal" and contractile function at rest in collateral-dependent myocardium of humans with ischemic heart disease.

作者信息

Holmvang G, Fry S, Skopicki H A, Abraham S A, Alpert N M, Fischman A J, Picard M H, Gewirtz H

机构信息

Departments of Medicine (Cardiac Unit), Radiology, and Nuclear Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA.

出版信息

Circulation. 1999 May 18;99(19):2510-6. doi: 10.1161/01.cir.99.19.2510.

DOI:10.1161/01.cir.99.19.2510

PMID:10330381

Abstract

BACKGROUND

We tested the hypothesis that rest asynergy in collateral-dependent myocardium correlates with coronary steal.

METHODS AND RESULTS

PET with [13N]ammonia measured myocardial blood flow and flow reserve in 15 patients with symptomatic chronic ischemic heart disease. Coronary angiography assessed stenosis severity and collateral blood supply. Echocardiography or contrast ventriculography evaluated regional wall motion. Collateral-dependent segments with normal flow at rest and supplied by coronary vessels having </=50% diameter stenosis were studied. Steal was defined as a decline in myocardial blood flow with adenosine >/=0.15 mL. min-1. g-1 versus rest. Blood flow at rest in asynergic, collateral-dependent segments with steal (1.15+/-0.35 mL. min-1. g-1) exceeded (P<0.0001) that of asynergic segments without steal (0.81+/-0.24) and those with normal contraction (0.77+/-0.18). Although the flow reserve ratio of segments with normal contraction (1.8+/-0.8) exceeded that of asynergic ones with (0.6+/-0.1) or without (1.3+/-0.4) steal, overlap was great. Correlation between basal contraction and flow reserve ratio in collateral-dependent myocardium was significant but weak (r=0.45, P<0.001). However, segments demonstrating "steal" with adenosine manifested asynergy in 22 of 23 collateral-dependent segments versus 24 of 39 nonsteal segments (chi2=7.10, P<0.01).

CONCLUSIONS

Although myocardial flow reserve in collateral-dependent segments with normal contraction exceeded that of asynergic segments, overlap was great. However, in patients with angina or congestive heart failure, left ventricular segments demonstrating steal with adenosine almost always exhibit asynergy at rest. Thus, coronary steal may play an important role in the pathogenesis of chronic contractile impairment at rest, whereas simple reduction of flow reserve may be less important in selected patients.

摘要

背景

我们检验了以下假设，即侧支循环依赖心肌中的静息失协同与冠状动脉窃血相关。

方法与结果

对15例有症状的慢性缺血性心脏病患者进行了用[13N]氨的正电子发射断层扫描（PET），以测量心肌血流和血流储备。冠状动脉造影评估狭窄严重程度和侧支循环供血情况。超声心动图或对比心室造影评估局部室壁运动。研究了静息时血流正常且由直径狭窄≤50%的冠状动脉供血的侧支循环依赖节段。窃血定义为腺苷激发后心肌血流较静息时下降≥0.15 mL·min-1·g-1。有窃血的失协同侧支循环依赖节段的静息血流（1.15±0.35 mL·min-1·g-1）超过（P<0.0001）无窃血的失协同节段（0.81±0.24）和收缩正常的节段（0.77±0.18）。尽管收缩正常节段的血流储备比（1.8±0.8）超过有（0.6±0.1）或无（1.3±0.4）窃血的失协同节段，但重叠很大。侧支循环依赖心肌的基础收缩与血流储备比之间的相关性显著但较弱（r=0.45，P<0.001）。然而，23个侧支循环依赖节段中有22个在腺苷激发下表现出“窃血”的节段出现失协同，而39个无窃血节段中有24个出现失协同（χ2=7.10，P<0.01）。