Nitenberg A, Aptecar E, Benvenuti C, Benhaiem N, Tavolaro O, Loisance D, Cachera J P
Service d'Explorations Fonctionnelles, Institut National de la Santé et de la Recherche Médicale, Unité 251, Centre Hospitalier et Universitaire Xavier-Bichat, Paris, France.
J Am Coll Cardiol. 1992 Nov 15;20(6):1333-8. doi: 10.1016/0735-1097(92)90245-i.
This study examined whether previous rejection episodes may have deleterious effects on coronary vascular reserve of heart transplant recipients months after transplantation.
Coronary reserve has been demonstrated to be within the normal range in long-term transplant patients without previous episodes of rejection. Conversely, acute rejection is associated with a dramatic reduction of coronary reserve, which is rapidly restored after therapy.
Coronary flow velocity was measured by intracoronary Doppler catheter before and after a maximally vasodilating dose of intracoronary papaverine in 16 control subjects and in 59 transplant patients classified into three groups with respect to time after transplantation: 1 to 6 months (group 1, n = 17), 7 to 18 months (group 2, n = 22) and > 18 months (group 3, n = 20). Coronary vascular reserve was evaluated through peak/rest coronary flow velocity ratio and minimal coronary vascular resistance index. All patients had normal findings on left ventricular angiography and coronary arteriography and a normal left ventricular mass.
Arterial pressure was normal in all groups. Heart rate in the three groups of transplant patients, mean aortic pressure in groups 1 and 2, left ventricular systolic pressure in group 2 and rate-pressure product in groups 1 and 2 were higher than in control subjects. Average number of rejection episodes per patient was similar in the three groups of patients (group 1, 2.4 +/- 1.4; group 2, 2.5 +/- 1.9, and group 3, 2.1 +/- 1.3). Results showed no difference between each group of transplant patients and control subjects for peak/rest coronary flow velocity ratio (control subjects, 5.2 +/- 0.8; group 1, 5.3 +/- 1.5; group 2, 4.9 +/- 1.2, and group 3, 4.4 +/- 1.6) and for minimal coronary vascular resistance index (control subjects, 0.18 +/- 0.03; group 1, 0.18 +/- 0.04; group 2, 0.20 +/- 0.06, group 3, 0.23 +/- 0.11). In addition, patients with zero or one rejection episode had similar values of peak/rest coronary flow velocity ratio and minimal coronary vascular resistance index (4.3 +/- 1.3 and 0.23 +/- 0.10, respectively, n = 22) as did those with one or two rejection episodes (5.1 +/- 1.5 and 0.19 +/- 0.07, respectively, n = 24), and those with four or more episodes (5.2 +/- 1.4 and 0.19 +/- 0.05, respectively, n = 13).
This study showed that coronary vascular reserve remains within normal range and is independent from the number of previous episodes of rejection until late after transplantation in human heart transplant patients with angiographically normal coronary arteries.
本研究旨在探讨既往排斥反应发作是否会对心脏移植受者移植数月后的冠状动脉血管储备产生有害影响。
在无既往排斥反应发作的长期移植患者中，冠状动脉储备已被证明处于正常范围内。相反，急性排斥反应与冠状动脉储备的显著降低有关，治疗后可迅速恢复。
在16名对照受试者和59名移植患者中，通过冠状动脉内多普勒导管在冠状动脉内注射最大剂量血管扩张剂罂粟碱前后测量冠状动脉血流速度。根据移植后的时间将移植患者分为三组：1至6个月（第1组，n = 17）、7至18个月（第2组，n = 22）和> 18个月（第3组，n = 20）。通过峰值/静息冠状动脉血流速度比值和最小冠状动脉血管阻力指数评估冠状动脉血管储备。所有患者左心室造影和冠状动脉造影结果正常，左心室质量正常。
所有组的动脉压均正常。三组移植患者的心率、第1组和第2组的平均主动脉压、第2组的左心室收缩压以及第1组和第2组的心率-血压乘积均高于对照受试者。三组患者中每位患者的平均排斥反应发作次数相似（第1组，2.4±1.4；第2组，2.5±1.9；第3组，2.1±1.3）。结果显示，移植患者每组与对照受试者在峰值/静息冠状动脉血流速度比值（对照受试者，5.2±0.8；第1组，5.3±1.5；第2组，4.9±1.2；第3组，4.4±1.6）和最小冠状动脉血管阻力指数（对照受试者，0.18±0.03；第1组，0.18±0.04；第2组，0.20±0.06；第3组，0.23±0.11）方面无差异。此外，排斥反应发作次数为零或一次的患者的峰值/静息冠状动脉血流速度比值和最小冠状动脉血管阻力指数（分别为4.3±1.3和0.23±0.10，n = 22）与发作次数为一或两次的患者（分别为5.1±1.5和0.19±0.07，n = 24）以及发作次数为四次或更多次的患者（分别为5.2±1.4和0.19±0.05，n = 13）相似。
本研究表明，在冠状动脉造影正常的人类心脏移植患者中，直到移植后期，冠状动脉血管储备仍保持在正常范围内，且与既往排斥反应发作次数无关。
