Saitoh Shu-Ichi, Muto Misturu, Osugi Taku, Aikawa Kazuhiko, Matsumoto Ken, Onogi Futoshi, Maehara Kazuhira, Ishibashi Toshiyuki, Maruyama Yukio
First Department of Internal Medicine, Fukushima Medical University, Japan.
Coron Artery Dis. 2004 May;15(3):137-45. doi: 10.1097/00019501-200405000-00002.
This study was conducted to develop a spontaneous coronary spasm model.
Balloon endothelial denudation was carried out in the epicardial left anterior descending coronary artery (LAD) every 2 weeks, for a total of four times, in 12 pigs. Changes in the denuded site diameter and LAD blood flow caused by acetylcholine or serotonin were assessed before each denudation and at week 8. Blood pressure, electrocardiogram (ECG) from the LAD area and LAD blood flow were monitored continuously in conscious and unrestrained pigs.
Spontaneous ECG ST depression with a decrease in LAD blood flow appeared at around 2 weeks. In accordance with this, 0.5 microg/kg acetylcholine induced similar ECG and LAD blood flow changes without denuded site narrowing, suggesting microvascular spasm. Thereafter, ECG ST depression or elevation by serotonin via a denuded site spasm was found after 6 weeks and spontaneous ECG ST changes due to epicardial coronary artery spasm were observed.
Epicardial coronary artery endothelial injury may induce spontaneous vasospasticity in the downstream coronary microvessels as well as in the denuded portion, suggesting functional abnormality through the entire coronary arterial tree.
本研究旨在建立一种自发性冠状动脉痉挛模型。
对12头猪的左前降支冠状动脉（LAD）心外膜进行每隔2周一次的球囊内皮剥脱术，共进行4次。在每次剥脱术前及第8周评估乙酰胆碱或5-羟色胺引起的剥脱部位直径和LAD血流变化。对清醒且未受束缚的猪连续监测血压、LAD区域心电图（ECG）及LAD血流。
约2周时出现自发性ECG ST段压低伴LAD血流减少。据此，0.5μg/kg乙酰胆碱在无剥脱部位狭窄的情况下诱导了类似的ECG和LAD血流变化，提示微血管痉挛。此后，6周后发现5-羟色胺通过剥脱部位痉挛引起ECG ST段压低或抬高，并观察到由于心外膜冠状动脉痉挛导致的自发性ECG ST段变化。
心外膜冠状动脉内皮损伤可能诱导下游冠状动脉微血管以及剥脱部位出现自发性血管痉挛，提示整个冠状动脉树存在功能异常。
