Houghton J L, Prisant L M, Carr A A, von Dohlen T W, Frank M J
Department of Medicine, Medical College of Georgia, Augusta 30912.
Am Heart J. 1991 Apr;121(4 Pt 1):1107-12. doi: 10.1016/0002-8703(91)90669-9.
An impaired coronary vasodilator reserve has been demonstrated in all stages of hypertensive heart disease but is most likely in the setting of hypertrophy. The decrease in coronary flow reserve has, however, not been predictable previously. We postulated that flow reserve depression might be related to a left ventricular mass threshold. Seventy-two patients (82% with hypertension) with suspected ischemic heart disease who were found to be free of significant coronary artery disease at cardiac catheterization were evaluated utilizing the intracoronary Doppler catheter and two-dimensional directed M-mode echocardiography for determination of coronary flow reserve and left ventricular mass. For left ventricular mass indexed (LVMI) by body surface area (BSA) greater than or equal to 50% above normal using established gender-specific norms, American Society of Echocardiography (ASE) and PENN methods (correction of LV mass by regression equation agreeing with necropsy estimates of mass) predicted impairment of flow reserve (p = 0.005 and 0.009, respectively). Unindexed left ventricular mass and LVMI by height were not helpful in this regard. Using the ASE method for LV mass determination, coronary flow reserve was moderately depressed (2.4 +/- 1.0) for those with LVMI greater than or equal to 50% above normal; in comparison, flow reserve was normal (3.5 +/- 1.3) for those with LVMI less than 50% above normal. A rare patient was able to maintain a normal flow reserve when ASE- and Penn-indexed mass estimates were greater than or equal to 50% above normal, but only in the setting of a markedly elevated mean arterial pressure.
在高血压性心脏病的各个阶段均已证实存在冠状动脉血管舒张储备受损的情况，而在心肌肥厚的情况下这种受损最为明显。然而，此前冠状动脉血流储备的降低情况一直无法预测。我们推测血流储备降低可能与左心室质量阈值有关。对72例疑似缺血性心脏病的患者（82%患有高血压）进行了评估，这些患者在心脏导管检查中被发现无明显冠状动脉疾病，采用冠状动脉内多普勒导管和二维定向M型超声心动图来测定冠状动脉血流储备和左心室质量。对于根据已确立的性别特异性标准，左心室质量指数（LVMI）通过体表面积（BSA）计算大于或等于正常水平50%以上的患者，美国超声心动图学会（ASE）和宾夕法尼亚大学（PENN）的方法（通过回归方程校正左心室质量以使其与尸检估计的质量相符）预测血流储备受损（分别为p = 0.005和0.009）。未根据身高进行指数化的左心室质量和LVMI在这方面并无帮助。使用ASE方法测定左心室质量时，对于LVMI大于或等于正常水平50%以上的患者，冠状动脉血流储备中度降低（2.4 +/- 1.0）；相比之下，对于LVMI低于正常水平50%以上的患者，血流储备正常（3.5 +/- 1.3）。当ASE和宾夕法尼亚大学指数化的质量估计值大于或等于正常水平50%以上时，只有在平均动脉压显著升高的情况下，才有极少数患者能够维持正常的血流储备。
