Yanagi Shiro, Hirota Kazuyoshi, Nagae Keiji, Abe Yukio, Hasegawa Takao, Okada Masako, Ota Takahiro, Yoshikawa Junichi
Department of Cardiology, Seichokai Fuchu Hospital, Hiko-cho 1-10-17, Izumi, Osaka 594-0076.
J Cardiol. 2002 Jan;39(1):1-10.
This study compared the hyperemic responses to adenosine triphosphate (ATP) administered by intravenous and by intracoronary injection in patients with impaired coronary microcirculation.
The hyperemic responses to intravenous and intracoronary administration of ATP in 107 patients (mean age 63 +/- 10 years, 77 males, 30 females) with impaired coronary circulation [including myocardial infarction (n = 68), cardiomyopath (n = 20) and diabetes mellitus (n = 11)] were compared by measurement of coronary flow reserve (CFR) using the Doppler guide wire. Patients with chest pain syndrome were used as the normal controls. The coronary blood flow velocity was measured at rest and during peak hyperemic responses to intravenous infusion (150 micrograms/kg/min) and intracoronary infusion of ATP (50 micrograms in the left coronary artery, 25 micrograms in the right coronary artery). The CFR was calculated as the ratio of averaged peak velocity during hyperemia to baseline averaged peak velocity.
The CFR after intravenous administration of ATP (CFRi.v.) was well correlated with CFR by intracoronary administration of ATP(CFRic) (r = 0.77, p < 0.001). However, the CFRi.v. was also inversely correlated with the ratio of CFRic to CFRiv (CFRic/i.v.) (r = -0.36, p < 0.001). There were no relationships between the changes of hemodynamic parameters(blood pressure and heart rate) induced by ATP and CFRic/i.v. A lower CFRi.v. of less than 2.0 provided significantly greater CFRic/i.v. than that of CFRiv greater than 2.0.
The maximal hyperemic response of coronary artery was not always induced by conventional intravenous administration of ATP, especially in patients with lower CFR than 2.0. High dose of intravenous ATP and/or intracoronary ATP should be administered in patients with lower CFR to attain maximum hyperemia in the impaired coronary circulation.
本研究比较了冠状动脉微循环受损患者经静脉注射和冠状动脉内注射三磷酸腺苷（ATP）后的充血反应。
采用多普勒导丝测量冠状动脉血流储备（CFR），比较107例（平均年龄63±10岁，男性77例，女性30例）冠状动脉循环受损患者（包括心肌梗死患者68例、心肌病患者20例和糖尿病患者11例）经静脉和冠状动脉内注射ATP后的充血反应。以胸痛综合征患者作为正常对照。在静息状态以及对静脉输注ATP（150微克/千克/分钟）和冠状动脉内输注ATP（左冠状动脉50微克，右冠状动脉25微克）的充血反应峰值期间测量冠状动脉血流速度。CFR计算为充血期平均峰值速度与基线平均峰值速度之比。
静脉注射ATP后的CFR（CFRi.v.）与冠状动脉内注射ATP后的CFR（CFRic）密切相关（r = 0.77，p < 0.001）。然而，CFRi.v.也与CFRic与CFRiv的比值（CFRic/i.v.）呈负相关（r = -0.36，p < 0.001）。ATP诱导的血流动力学参数（血压和心率）变化与CFRic/i.v.之间无相关性。CFRi.v.低于2.0时，其CFRic/i.v.显著高于CFRiv大于2.0时。
传统静脉注射ATP并不总能诱发冠状动脉的最大充血反应，尤其是在CFR低于2.0的患者中。对于CFR较低的患者，应给予高剂量静脉ATP和/或冠状动脉内ATP，以在受损的冠状动脉循环中实现最大充血。
