主动脉瓣置换术后主动脉狭窄患者的冠状动脉血流储备改善：一项腺苷经胸超声心动图研究。
Coronary flow reserve improves after aortic valve replacement for aortic stenosis: an adenosine transthoracic echocardiography study.
作者信息
Hildick-Smith D J, Shapiro L M
机构信息
Cardiac Unit, Papworth Hospital, Cambridge, United Kingdom.
出版信息
J Am Coll Cardiol. 2000 Nov 15;36(6):1889-96. doi: 10.1016/s0735-1097(00)00947-5.
OBJECTIVES
The goal of this study was to assess coronary flow reserve (CFR) before and after aortic valve replacement (AVR).
BACKGROUND
Coronary flow reserve is impaired under conditions of left ventricular (LV) hypertrophy. It is not known whether CFR improves with regression of LV hypertrophy in humans.
METHODS
We investigated 35 patients with pure aortic stenosis, LV hypertrophy and normal coronary arteriograms. Patients underwent adenosine transthoracic echocardiography on two occasions--immediately before AVR and six months postoperatively. Left ventricular mass, distal left anterior descending coronary artery (LAD) diameter, flow and CFR were assessed on each occasion.
RESULTS
Distal LAD diameter was successfully imaged in 30 patients (86%), and blood flow was successfully imaged in 27 (77%). Paired data were subsequently available in 24 patients, of whom 14 were men, mean age 68.1+/-12.5 years, body mass index 24.5+/-2.0 kg/m2, aortic valve gradient 93+/-32 mm Hg. Pre- to post-AVR a significant decrease was seen in LV mass (271+/-38 vs. 236+/-32g, p<0.01) and LV mass index (154+/-21 vs. 134+/-21 g/m2, p< 0.01). Distal LAD diameter fell from 2.27+/-0.37 to 2.23+/-0.35 mm, p = 0.08). Pre- to post-AVR there was no significant change in resting parameters of peak diastolic velocity (0.43+/-0.16 vs. 0.41+/-0.11 m/s), distal LAD flow 23.3+/-10.1 vs. 20.9+/-5.2 ml/min or distal LAD flow scaled for LV mass (8.7+/-3.8 vs. 9.0+/-2.5 ml/min/100 g LV mass), but there was significant increase in hyperemic peak diastolic velocity (0.71+/-0.26 vs. 1.08+/-0.24 m/s; p<0.01), distal LAD flow (37.8+/-11.3 vs. 53.5+/-16.1 ml/min; p<0.01) and distal LAD flow scaled for LV mass (14.3+/-5.0 vs. 23.3+/-8.5 ml/min/100 g LV mass; p<0.01). Coronary flow reserve, therefore, increased from 1.76+/-0.5 to 2.61+/-0.7.
CONCLUSIONS
Coronary flow reserve increases after AVR for aortic stenosis. This increase occurs in tandem with regression of LV hypertrophy.
目的
本研究的目的是评估主动脉瓣置换术（AVR）前后的冠状动脉血流储备（CFR）。
背景
在左心室（LV）肥厚的情况下，冠状动脉血流储备受损。目前尚不清楚在人类中，随着LV肥厚的消退，CFR是否会改善。
方法
我们调查了35例患有单纯主动脉瓣狭窄、LV肥厚且冠状动脉造影正常的患者。患者在两个时间点接受腺苷经胸超声心动图检查——AVR前即刻和术后6个月。每次检查时评估左心室质量、左前降支远端冠状动脉（LAD）直径、血流和CFR。
结果
30例患者（86%）成功成像了LAD远端直径，27例（77%）成功成像了血流。随后有24例患者获得了配对数据，其中14例为男性，平均年龄68.1±12.5岁，体重指数24.5±2.0kg/m2，主动脉瓣压差93±32mmHg。AVR前后，LV质量（271±38 vs. 236±32g，p<0.01）和LV质量指数（154±21 vs. 134±21g/m2，p<0.01）显著降低。LAD远端直径从2.27±0.37mm降至2.23±0.35mm，p = 0.08）。AVR前后，舒张末期峰值速度（0.43±0.16 vs. 0.41±0.11m/s）、LAD远端血流（23.3±10.1 vs. 20.9±5.2ml/min）或根据LV质量调整的LAD远端血流（8.7±3.8 vs. 9.0±2.5ml/min/100g LV质量）的静息参数无显著变化，但充血期舒张末期峰值速度（0.71±0.26 vs. 1.08±0.24m/s；p<0.01）、LAD远端血流（37.8±11.3 vs. 53.5±16.1ml/min；p<0.01）和根据LV质量调整的LAD远端血流（14.3±5.0 vs. 23. \3±8.5ml/min/100g LV质量；p<0.01）显著增加。因此，冠状动脉血流储备从1.76±0.5增加到2.61±0.7。
结论
主动脉瓣狭窄患者AVR后冠状动脉血流储备增加。这种增加与LV肥厚的消退同步发生。
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