Petkow Dimitrow P, Krzanowski M, Nizankowski R, Szczeklik A, Dubiel J S
Second Department of Cardiology, Jagiellonian University School of Medicine, ul Kopernika 17, 31-501 Krakow, Poland.
Heart. 2000 Mar;83(3):262-6. doi: 10.1136/heart.83.3.262.
To assess non-invasively the effect of verapamil treatment on coronary blood flow velocity in asymptomatic and mildly symptomatic patients with hypertrophic cardiomyopathy.
High frequency transthoracic Doppler echocardiography was used to compare resting phasic coronary blood flow velocity before and after a one month period of verapamil treatment in 17 patients (14 men and three women) with non-obstructive hypertrophic cardiomyopathy. Eighteen healthy subjects formed an age and sex matched control group. Systolic and diastolic coronary blood flow velocity was measured in the distal portion of left anterior descending coronary artery using high frequency transthoracic Doppler echocardiography. Blood flow velocity before and after verapamil was compared in the patients with cardiomyopathy and with the results in the control group.
Compared with the controls, patients with hypertrophic cardiomyopathy had increased diastolic coronary blood flow velocity (41.8 (8.1) v 59.9 (21.9) cm/s, p < 0.01) and a lower mean systolic coronary blood flow velocity (18.7 (10.8) v -11.2 (27.5) cm/s, p < 0. 01) before verapamil treatment. A backward pattern of systolic flow, manifested by negative values of coronary blood flow velocity, was recorded in eight of the patients, while no negative values were found in the controls. After verapamil treatment the retrograde systolic blood flow was restored to an anterograde pattern in only one patient. The mean value of systolic coronary blood flow velocity did not change significantly and remained lower than the systolic forward flow velocity in the controls (-3.6 (31.8) v 18.7 (10.8) cm/s, p < 0.05). However, diastolic coronary blood flow velocity decreased significantly after verapamil (59.9 (21.9) v 50.7 (19.5) cm/s p < 0.05), reaching a level comparable with that in the controls (50.7 (19.5) v 41.8 (8.1) cm/s, p > 0.05).
In contrast to healthy subjects, in non-obstructive hypertrophic cardiomyopathy the systolic pattern of coronary blood flow was heterogeneous (both retrograde and anterograde), and diastolic coronary blood flow velocity was abnormally increased, despite a lack of significant symptoms. Verapamil treatment did not restore the forward pattern of systolic blood flow but decreased diastolic blood flow velocity to a level comparable with that in healthy subjects.
无创评估维拉帕米治疗对无症状及轻度症状肥厚型心肌病患者冠状动脉血流速度的影响。
采用高频经胸多普勒超声心动图，比较17例（14例男性和3例女性）非梗阻性肥厚型心肌病患者在维拉帕米治疗1个月前后静息状态下的阶段性冠状动脉血流速度。18名健康受试者组成年龄和性别匹配的对照组。使用高频经胸多普勒超声心动图测量左前降支冠状动脉远端的收缩期和舒张期冠状动脉血流速度。比较心肌病患者维拉帕米治疗前后的血流速度，并与对照组结果进行比较。
与对照组相比，肥厚型心肌病患者在维拉帕米治疗前舒张期冠状动脉血流速度增加（41.8（8.1）对59.9（21.9）cm/s，p<0.01），平均收缩期冠状动脉血流速度较低（18.7（10.8）对-11.2（27.5）cm/s，p<0.01）。8例患者记录到收缩期血流呈逆向模式，表现为冠状动脉血流速度为负值，而对照组未发现负值情况。维拉帕米治疗后，仅1例患者逆行收缩期血流恢复为顺行模式。收缩期冠状动脉血流速度平均值无显著变化，仍低于对照组的收缩期正向血流速度（-3.6（31.8）对18.7（10.8）cm/s，p<0.05）。然而，维拉帕米治疗后舒张期冠状动脉血流速度显著降低（59.9（21.9）对50.7（19.5）cm/s，p<0.05），降至与对照组相当的水平（50.7（19.5）对41.8（8.1）cm/s，p>0.05）。
与健康受试者不同，在非梗阻性肥厚型心肌病中，尽管没有明显症状，但冠状动脉血流的收缩期模式是异质性的（既有逆行又有顺行），舒张期冠状动脉血流速度异常增加。维拉帕米治疗未恢复收缩期血流的正向模式，但将舒张期血流速度降低至与健康受试者相当的水平。
