Nemes Attila, Forster Tamás, Csanády Miklós
2nd Department of Medicine and Cardiology Center, Albert Szent-Györgyi Medical and Pharmaceutical Center, University of Szeged, Hungary.
J Heart Valve Dis. 2004 Jul;13(4):567-73.
A number of clinical and experimental studies have suggested that aortic valve stenosis (AS) is a manifestation of atherosclerotic process. Previous studies have revealed a decreased coronary flow velocity reserve (CFR) in AS patients in consequence of left ventricular hypertrophy. The hypothesis was tested that the elastic properties of the descending aorta of AS patients might indicate signs of stiffness of the aorta.
The CFR and indices of aortic distensibility as functional markers of the descending aorta were compared in three different patient populations: (i) control subjects without valvular and coronary artery disease; (ii) patients with AS with normal epicardial coronary arteries; and (iii) patients with significant left anterior descending coronary artery (LAD) stenosis. CFR measurements were carried out according to a standard protocol, using vasodilatory stimulation with dipyridamole (0.56 mg/kg for 4 min), and peak diastolic velocity measurements at 6 min. The elastic properties of the aorta were calculated from echocardiographic parameters and blood pressure data.
The CFR in AS patients was decreased to a similar extent as in patients with LAD stenosis. The aortic distensibility indices were similarly significantly increased in patients with AS and normal epicardial coronary arteries and with LAD stenosis, as compared with controls.
These results indicate that the descending aorta exhibits appreciable increased stiffness in AS patients with normal epicardial coronary arteries.
多项临床及实验研究表明，主动脉瓣狭窄（AS）是动脉粥样硬化过程的一种表现。既往研究显示，由于左心室肥厚，AS患者的冠状动脉血流速度储备（CFR）降低。本研究旨在验证一个假设，即AS患者降主动脉的弹性特性可能提示主动脉僵硬的迹象。
比较了三组不同患者群体降主动脉的功能标志物CFR及主动脉扩张性指标：（i）无瓣膜及冠状动脉疾病的对照受试者；（ii）心外膜冠状动脉正常的AS患者；（iii）左前降支冠状动脉（LAD）严重狭窄的患者。根据标准方案进行CFR测量，使用双嘧达莫（0.56 mg/kg，持续4分钟）进行血管舒张刺激，并在6分钟时测量舒张末期峰值速度。根据超声心动图参数和血压数据计算主动脉的弹性特性。
AS患者的CFR降低程度与LAD狭窄患者相似。与对照组相比，心外膜冠状动脉正常的AS患者和LAD狭窄患者的主动脉扩张性指标同样显著增加。
这些结果表明，在心外膜冠状动脉正常的AS患者中，降主动脉表现出明显的僵硬增加。
