Lucarini A R, Picano E, Lattanzi F, Camici P, Marini C, Salvetti A, L'Abbate A
CNR Clinical Physiology Institute, University of Pisa, Italy.
Circulation. 1991 May;83(5 Suppl):III68-72.
Arterial hypertension can provoke a reduction in coronary flow reserve through several mechanisms that are not mutually exclusive, namely, coronary artery disease, left ventricular hypertrophy, and microvascular disease. These different targets of arterial hypertension should be explored with different diagnostic markers. The transient dyssynergy detected by two-dimensional echocardiography and evoked during dipyridamole infusion is a marker of coronary disease that is equally reliable in normotensive and hypertensive individuals. On the contrary, dipyridamole-induced ST segment depression is frequently elicited in hypertensive patients when angiographically assessed coronary disease is absent. This ischemiclike electrocardiographic response can be found in echocardiographically assessed left ventricular hypertrophy. However, even when left ventricular mass is normal, dipyridamole-induced ST segment depression is associated with an impaired coronary flow response to pacing, which is consistent with microvascular disease. Whether echocardiographically silent electrocardiographic changes are simply diagnostic noises transmitting a misleading false positive response or a potentially important clinical marker of early myocardial damage remains a pivotal though still unanswered question.
动脉高血压可通过几种并非相互排斥的机制导致冠状动脉血流储备减少，即冠状动脉疾病、左心室肥厚和微血管疾病。应使用不同的诊断标志物来探究动脉高血压的这些不同靶点。二维超声心动图检测到并在双嘧达莫输注期间诱发的短暂性运动失调是冠状动脉疾病的一个标志物，在血压正常和高血压个体中同样可靠。相反，在血管造影评估显示无冠状动脉疾病时，高血压患者常出现双嘧达莫诱发的ST段压低。这种类似缺血的心电图反应可见于超声心动图评估的左心室肥厚患者。然而，即使左心室质量正常，双嘧达莫诱发的ST段压低也与起搏时冠状动脉血流反应受损有关，这与微血管疾病一致。超声心动图显示的无症状心电图改变究竟只是传递误导性假阳性反应的诊断噪声，还是早期心肌损伤的潜在重要临床标志物，仍然是一个关键但尚未得到解答的问题。
