Sueda Shozo, Kohno Hiroaki, Fukuda Hiroshi, Uraoka Tadao
Department of Cardiology, Saiseikai Saijo Hospital, Tsuitachi 269-1, Saijo City, Ehime Prefecture 793-0027, Japan.
Coron Artery Dis. 2003 Sep;14(6):423-9. doi: 10.1097/00019501-200309000-00002.
This study sought to assess the coronary flow reserve (CFR) in patients with pure vasospastic angina (VSA).
The phasic flow velocities of both spasm-positive and spasm-negative coronary arteries of the left anterior descending artery (LAD) were recorded at rest and during hyperaemia (50 microg of adenosine triphosphate infusion intracoronary) using a 0.014 inch, 15 MHz Doppler guide wire in 42 patients with pure VSA and acetylcholine (ACh)-induced coronary artery spasms (20-100 microg), and 23 controls with normal coronary arteries without ACh-induced vasospasm. These 42 patients had 16 vessels with focal spasms (>99%), 17 vessels with diffuse spasms (>90%) in the LAD, and nine vessels with ACh-induced spasms in the right coronary artery, but not the LAD. Coronary flow reserve was obtained from the ratio of the hyperaemic/baseline time-averaged peak velocity. Coronary flow reserve did not differ between patients with VSA and the controls (2.9+/-0.8 versus 3.2+/-0.7, NS). Moreover, CFR did not differ among the four cases (focal: 2.8+/-0.7; diffuse: 3.0+/-0.9; non spasm: 2.9+/-0.7 versus controls: 3.2+/-0.7, respectively, NS). Coronary flow reserve in vessels with proximal spasms was significantly higher than that in vessels with mid or distal spasms (3.4+/-0.8 versus 2.6+/-0.6, 2.6+/-0.9, p<0.05). The only significant correlation was between CFR and age (p=0.0275) or the duration of angina before admission (p=0.0405).
There was no difference in CFR in patients with ACh-induced spasms between the spasm-positive and spasm-negative vessels. Moreover, CFR was maintained normally in vessels with diffuse spasms, as in those with focal spasms. The most important determinant factors for CFR in patients with VSA were age and the duration of angina before admission.
本研究旨在评估单纯血管痉挛性心绞痛（VSA）患者的冠状动脉血流储备（CFR）。
使用0.014英寸、15兆赫兹的多普勒导丝，记录了42例单纯VSA且有乙酰胆碱（ACh）诱发冠状动脉痉挛（20 - 100微克）患者以及23例无ACh诱发血管痉挛的正常冠状动脉对照者静息时和充血时（冠状动脉内注入50微克三磷酸腺苷）左前降支（LAD）痉挛阳性和痉挛阴性冠状动脉的阶段性血流速度。这42例患者中，LAD有16支血管出现局灶性痉挛（>99%），17支血管出现弥漫性痉挛（>90%），右冠状动脉有9支血管出现ACh诱发的痉挛，但LAD未出现。冠状动脉血流储备通过充血期/基线期时间平均峰值速度的比值获得。VSA患者与对照组之间的冠状动脉血流储备无差异（2.9±0.8对3.2±0.7，无显著性差异）。此外，四组情况（局灶性：2.8±0.7；弥漫性：3.0±0.9；无痉挛：2.9±0.7对对照组：3.2±0.7）之间的CFR也无差异（均无显著性差异）。近端痉挛血管的冠状动脉血流储备显著高于中段或远端痉挛血管（3.4±0.8对2.6±0.6，2.6±0.9，p<0.05）。唯一显著的相关性存在于CFR与年龄（p = 0.0275）或入院前心绞痛持续时间（p = 0.0405）之间。
ACh诱发痉挛的患者中，痉挛阳性和痉挛阴性血管之间的CFR无差异。此外，弥漫性痉挛血管的CFR与局灶性痉挛血管一样保持正常。VSA患者CFR的最重要决定因素是年龄和入院前心绞痛的持续时间。
