Cin V Gökhan, Pekdemir Hasan, Camsar Ahmet, Ciçek Dilek, Akkus M Necdet, Parmaksýz Tuncay, Katýrcýbaý Tuna, Döven Oben
Department of Cardiology, Faculty of Medicine, University of Mersin, Mersin, Turkey.
Jpn Heart J. 2003 Nov;44(6):907-19. doi: 10.1536/jhj.44.907.
Intravascular ultrasound imaging can detect intimal thickening and is suitable for detection of early atherosclerosis, which cannot be detected by conventional angiography. The aim of the present study was to investigate the epicardial coronary morphology and intracoronary pressure in relation to slow coronary flow (SCF). The study population consisted of 19 patients with SCF [11 (57.9%) females; 55.95 +/- 9.42 years]. Proximal, middle, distal and mean total vessel area, lumen area, intima + media area (IMA), percent IMA, and maximal intima + media (I + M) thickness were calculated and compared to healthy subjects. Proximal, middle, distal and mean I + M thickness, IMA, and % IMA of patients with SCF were found to be significantly higher than those of control subjects. Longitudinally extended massive calcification throughout the epicardial arteries was found in 13 (68.49%) patients with SCF and regional calcification was found in 6 (31.6%) patients with SCF. Proximal and distal pressure gradients of patients with SCF were determined to be 15.84 +/- 12.11 mmHg in the intracoronary pressure measurements. Fractional flow reserve values were significantly lower than the normal population (0.83 +/- 0.13, P < 0.0001). This study indicates that patients with SCF have diffuse intimal thickening, widespread calcification along the vessel wall and atheroma which does not cause luminal irregularities in coronary angiography, and a pressure gradient between proximal and distal segments of epicardial coronary arteries with SCF. Based on these results, we believe that SCF may be a form of diffuse atherosclerosis involving both the microvascular system and epicardial coronary arteries.
血管内超声成像可检测内膜增厚，适用于早期动脉粥样硬化的检测，而传统血管造影无法检测到这种情况。本研究的目的是调查与冠状动脉血流缓慢（SCF）相关的心外膜冠状动脉形态和冠状动脉内压力。研究对象包括19例SCF患者[11例（57.9%）女性；年龄55.95±9.42岁]。计算近端、中段、远端和平均总血管面积、管腔面积、内膜+中膜面积（IMA）、IMA百分比以及最大内膜+中膜（I+M）厚度，并与健康受试者进行比较。发现SCF患者的近端、中段、远端和平均I+M厚度、IMA和IMA百分比显著高于对照组。在13例（68.49%）SCF患者中发现心外膜动脉全程纵向广泛钙化，6例（31.6%）SCF患者发现局部钙化。在冠状动脉内压力测量中，SCF患者的近端和远端压力梯度为15.84±12.11 mmHg。血流储备分数值显著低于正常人群（0.83±0.13，P<0.0001）。本研究表明，SCF患者存在弥漫性内膜增厚、沿血管壁广泛钙化以及冠状动脉造影中不引起管腔不规则的动脉粥样硬化，且SCF患者心外膜冠状动脉近端和远端节段之间存在压力梯度。基于这些结果，我们认为SCF可能是一种涉及微血管系统和心外膜冠状动脉的弥漫性动脉粥样硬化形式。
