Negishi K, Handa S, Asakura Y, Iwanaga S, Ishikawa S, Wainai Y, Abe S, Tani M
Department of Internal Medicine, School of Medicine, Keio University.
Kokyu To Junkan. 1991 Oct;39(10):1021-7.
We compared the pattern and reserve of coronary flow in 8 cases of hypertrophic non-obstructive cardiomyopathy (H) with those in 20 cases of chest pain not accompanied by organic heart disease (N). A catheter-tip Doppler velocimeter was positioned in the proximal portion of the left anterior descending (LAD), circumflex (LCX) and right coronary (RCA) arteries. Coronary flow velocity (Vs: systolic peak, Vd: diastolic peak, Vm: mean) was recorded and the area under the velocity curve was divided into systole (* s) and diastole (* d). The time interval between the dicrotic notch in aortic pressure and the peak of diastolic flow velocity was measured (Tpv). Vm was measured before and after intracoronary injection of 6 ml of contrast media, and peak to resting velocity ratio (PRVR) was calculated as an index of coronary flow reserve.
In LAD, N showed diastolic predominant coronary flow pattern without backward flow. In H, diastolic predominance was more prominent with systolic backward flow, resulting in decrease in * s/* d(H: 0.07 +/- 0.04, N: 0.25 +/- 0.02, p less than 0.01). In H, Vd (H: 20.1 +/- 2.8, N: 9.2 +/- 1.4 cm/sec, p less than 0.05) and Vm(H: 9.5 +/- 1.3, N: 4.9 +/- 0.7 cm/sec, p less than 0.05) were higher, while PRVR was lower (H: 1.7 +/- 0.1, N: 2.6 +/- 0.1, p less than 0.05). In both N and H, the flow pattern of LCX was diastolic predominant with two peaks (one in systole and the other in diastole).(ABSTRACT TRUNCATED AT 250 WORDS)
我们比较了8例肥厚型非梗阻性心肌病（H）患者与20例无器质性心脏病的胸痛患者（N）的冠状动脉血流模式和储备情况。将导管尖端多普勒测速仪置于左前降支（LAD）、回旋支（LCX）和右冠状动脉（RCA）近端。记录冠状动脉血流速度（Vs：收缩期峰值，Vd：舒张期峰值，Vm：平均值），并将速度曲线下面积分为收缩期（*s）和舒张期（*d）。测量主动脉压力的重搏切迹与舒张期血流速度峰值之间的时间间隔（Tpv）。在冠状动脉内注射6 ml造影剂前后测量Vm，并计算峰值与静息速度比（PRVR）作为冠状动脉血流储备指标。
在LAD中，N组表现为以舒张期为主的冠状动脉血流模式且无逆流。在H组中，舒张期优势更为明显且伴有收缩期逆流，导致*s/*d降低（H组：0.07±0.04，N组：0.25±0.02，p<0.01）。在H组中，Vd（H组：20.1±2.8，N组：9.2±1.4 cm/秒，p<0.05）和Vm（H组：9.5±1.3，N组：4.9±0.7 cm/秒，p<0.05）较高，而PRVR较低（H组：1.7±0.1，N组：2.6±0.1，p<0.05）。在N组和H组中，LCX的血流模式均以舒张期为主且有两个峰值（一个在收缩期，另一个在舒张期）。（摘要截断于250字）
