无传统危险因素的单支冠状动脉疾病患者中，冠状动脉造影正常的冠状动脉的冠脉血流储备

Coronary flow reserve in angiographically normal coronary arteries with one-vessel coronary artery disease without traditional risk factors.

作者信息

Fujiwara M, Tamura T, Yoshida K, Nakagawa K, Nakao M, Yamanouchi M, Shikama N, Himi T, Masuda Y

机构信息

Third Department of Internal Medicine, Chiba University School of Medicine, Chiba, Japan.

出版信息

Eur Heart J. 2001 Mar;22(6):479-87. doi: 10.1053/euhj.2000.2428.

DOI:10.1053/euhj.2000.2428

PMID:11237543

Abstract

AIMS

Reduced coronary flow reserve has been reported in patients with traditional risk factors, in particular hyperlipidaemia, despite angiographically normal coronary arteries. However, it is recognized that traditional risk factors do not explain the presence of coronary atherosclerosis in a large proportion of patients. The aim of this study was to assess whether coronary flow reserve is preserved in the myocardium supplied by normal coronary arteries in patients with one-vessel coronary artery disease without traditional risk factors.

METHODS AND RESULTS

Positron emission tomography using [13N]ammonia was performed at baseline and after intravenous dipyridamole administration (0.56 mg x dl(-1)over 4 min) in 30 subjects: six patients with ischaemia on effort, no myocardial infarction, and isolated left anterior descending coronary artery stenosis without traditional risk factors (coronary artery disease patients without risk factors, aged 59+/-13), five patients with ischaemia on effort, no myocardial infarction, and isolated left anterior descending coronary artery stenosis with multiple risk factors (coronary artery disease patients with risk factors, aged 69+/-7), 11 age-matched controls (aged 58+/-6), and eight healthy young volunteers (aged 34+/-4). Myocardial blood flow calculated in the myocardium supplied by normal coronary arteries in the coronary artery disease patients was compared with those of the two control groups. Coronary flow reserve was defined as the ratio of hyperaemic blood flow after dipyridamole infusion to baseline blood flow. Although coronary flow reserve in the coronary artery disease patients with risk factors was significantly lower than that in the age-matched controls (1.62+/-0.37, 2.58+/-0.71, P=0.0428), coronary flow reserve in the coronary artery disease patients without risk factors was similar to that in the age-matched controls (2.54+/-0.17 vs 2.58+/-0.71, P=ns).

CONCLUSION

Coronary flow reserve is preserved in regions supplied by angiographically normal coronary arteries with one-vessel coronary artery disease without traditional risk factors.

摘要

目的

尽管冠状动脉造影显示正常，但已有报道称存在传统危险因素（尤其是高脂血症）的患者冠状动脉血流储备降低。然而，人们认识到传统危险因素并不能解释很大一部分患者冠状动脉粥样硬化的存在。本研究的目的是评估在无传统危险因素的单支冠状动脉疾病患者中，正常冠状动脉供血的心肌中冠状动脉血流储备是否得以保留。

方法与结果

对30名受试者在基线时以及静脉注射双嘧达莫（4分钟内0.56毫克/分升）后进行了使用[13N]氨的正电子发射断层扫描：6名运动时出现缺血、无心肌梗死且孤立性左前降支冠状动脉狭窄且无传统危险因素的患者（无危险因素的冠状动脉疾病患者，年龄59±13岁），5名运动时出现缺血、无心肌梗死且孤立性左前降支冠状动脉狭窄且有多种危险因素的患者（有危险因素的冠状动脉疾病患者，年龄69±7岁），11名年龄匹配的对照组（年龄58±6岁），以及8名健康年轻志愿者（年龄34±4岁）。将冠状动脉疾病患者中正常冠状动脉供血心肌的心肌血流量与两个对照组的进行比较。冠状动脉血流储备定义为双嘧达莫输注后充血血流与基线血流的比值。尽管有危险因素的冠状动脉疾病患者的冠状动脉血流储备显著低于年龄匹配的对照组（1.62±0.37，2.58±0.71，P = 0.0428），但无危险因素的冠状动脉疾病患者的冠状动脉血流储备与年龄匹配的对照组相似（2.54±0.17对2.58±0.71，P = 无显著性差异）。