Choi Bong-Ryong, Kim Jae Seung, Yang You Jung, Park Kyoung-Min, Lee Cheol Whan, Kim Yong-Hak, Hong Myeong-Ki, Song Jae-Kwan, Park Seong-Wook, Park Seung-Jung, Kim Jae-Joong
Department of Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Am J Cardiol. 2006 May 1;97(9):1365-9. doi: 10.1016/j.amjcard.2005.11.059. Epub 2006 Mar 20.
Cerebral blood flow (CBF) is decreased and cognitive dysfunction develops in the advanced stages of heart failure. However, few data are available regarding the factors associated with decreased CBF. Fifty-two patients with advanced congestive heart failure (CHF) secondary to idiopathic dilated cardiomyopathy (ejection fraction <or=35%) and 10 healthy volunteers were included in this study. Echocardiography and symptom-limited bicycle exercise testing were performed. Global CBF was measured by radionuclide angiography. Global CBF was 19% less in patients with CHF than in controls (p <0.01). Such reduced CBF became normalized in 4 patients with CHF who underwent cardiac transplantation. In a univariate linear regression analysis, global CBF was significantly associated with New York Heart Association functional class, disease duration, atrial fibrillation, serum B-type natriuretic peptide level, the early mitral velocity/early diastolic annular velocity ratio, and pulmonary artery systolic pressure. Global CBF was not found to be associated with the ejection fraction, peak oxygen consumption, or anaerobic threshold. In a stepwise multivariate linear regression analysis, serum B-type natriuretic peptide level (p = 0.047) and New York Heart Association functional class (p = 0.003) were significantly related to global CBF (global CBF = 48.373 - 0.05 x serum B-type natriuretic peptide level - 3.283 x New York Heart Association functional class; r(2) = 0.401). In conclusion, CBF is decreased in patients with CHF, which may be used to predict disease severity and chronicity.
在心力衰竭晚期，脑血流量（CBF）会减少，并出现认知功能障碍。然而，关于与CBF降低相关的因素，目前可用的数据很少。本研究纳入了52例因特发性扩张型心肌病继发的晚期充血性心力衰竭（CHF）患者（射血分数≤35%）和10名健康志愿者。进行了超声心动图检查和症状限制性自行车运动试验。通过放射性核素血管造影测量全脑血流量。CHF患者的全脑血流量比对照组低19%（p<0.01）。4例接受心脏移植的CHF患者的这种降低的CBF恢复正常。在单变量线性回归分析中，全脑血流量与纽约心脏协会功能分级、病程、心房颤动、血清B型利钠肽水平、二尖瓣早期流速/舒张早期环周速度比值以及肺动脉收缩压显著相关。未发现全脑血流量与射血分数、峰值耗氧量或无氧阈值相关。在逐步多变量线性回归分析中，血清B型利钠肽水平（p = 0.047）和纽约心脏协会功能分级（p = 0.003）与全脑血流量显著相关（全脑血流量 = 48.373 - 0.05×血清B型利钠肽水平 - 3.283×纽约心脏协会功能分级；r² = 0.401）。总之，CHF患者的CBF降低，这可能用于预测疾病的严重程度和慢性程度。
