Kern M J, Deligonul U, Tatineni S, Serota H, Aguirre F, Hilton T C
Cardiology Division, St. Louis University Hospital, Missouri 63110-0250.
J Am Coll Cardiol. 1991 Sep;18(3):718-29. doi: 10.1016/0735-1097(91)90795-b.
To assess the use of adenosine as an alternative agent for determination of coronary vasodilator reserve, hemodynamics and coronary blood flow velocity were measured at rest and during peak hyperemic responses to continuous intravenous adenosine infusion (50, 100 and 150 micrograms/kg per min for 3 min) and intracoronary papaverine (10 mg) in 34 patients (17 without [group 1] and 17 with [group 2] significant left coronary artery disease), and in 17 patients (11 without and 6 with left coronary artery disease) after low dose (2.5 mg) intravenous bolus injection of adenosine. The maximal adenosine dose did not change mean arterial pressure (-10 +/- 14% and -6 +/- 12% for groups 1 and 2, respectively) but increased the heart rate (15 +/- 18% and 13 +/- 16, respectively). For continuous adenosine infusions, mean coronary flow velocity increased 64 +/- 104%, 122 +/- 94% and 198 +/- 59% and 15 +/- 51%, 110 +/- 95% and 109 +/- 86% in groups 1 and 2, respectively for each of the three doses. Mean coronary flow velocity increased significantly after 100 and 150 micrograms/kg of adenosine and 10 mg of intracoronary papaverine (48 +/- 25, 52 +/- 19 and 54 +/- 21 cm/s, respectively; all p less than 0.05 vs. baseline) and was significantly higher than in group 2 (37 +/- 24, 32 +/- 16, 41 +/- 23 cm/s; all p less than 0.05 vs. group 1). The coronary vasodilator reserve ratio (calculated as the ratio of hyperemic to basal mean flow velocity) for adenosine and papaverine was 2.94 +/- 1.50 and 2.94 +/- 1.00, respectively, in group 1 and was significantly and similarly reduced in group 2 (2.16 +/- 0.81 and 2.38 +/- 0.78, respectively; both p less than 0.05 vs. group 1). Low dose bolus injection of adenosine increased mean velocity equivalently to that after continuous infusion of 100 micrograms/kg, but less than after papaverine. There was a strong correlation between adenosine infusion and papaverine for both mean coronary flow velocity and coronary vasodilator reserve ratio (r2 = 0.871 and 0.325; SEE = 0.068 and 0.189, respectively; both p less than 0.0005). No patient had significant arrhythmias or prolongation of the corrected QT (QTc) interval with adenosine, but papaverine increased the QT (QTc) interval from 445 +/- 44 to 501 +/- 43 ms (p less than 0.001 vs. both maximal adenosine and baseline) and produced nonsustained ventricular tachycardia in one patient.(ABSTRACT TRUNCATED AT 400 WORDS)
为评估使用腺苷作为测定冠状动脉扩张储备的替代药物的效果，对34例患者（17例无明显左冠状动脉疾病[第1组]和17例有明显左冠状动脉疾病[第2组]）以及17例患者（11例无左冠状动脉疾病和6例有左冠状动脉疾病）在静息状态下以及对持续静脉输注腺苷（50、100和150微克/千克每分钟，持续3分钟）和冠状动脉内注射罂粟碱（10毫克）的充血反应峰值期间测量血流动力学和冠状动脉血流速度。在静脉推注低剂量（2.5毫克）腺苷后也进行了测量。最大腺苷剂量未改变平均动脉压（第1组和第2组分别为-10±14%和-6±12%），但增加了心率（分别为15±18%和13±16）。对于持续腺苷输注，在第1组和第2组中，三种剂量各自对应的平均冠状动脉血流速度分别增加了64±104%、122±94%和198±59%以及15±51%、110±95%和109±86%。在输注100和150微克/千克的腺苷以及10毫克冠状动脉内罂粟碱后，平均冠状动脉血流速度显著增加（分别为48±25、52±19和54±21厘米/秒；与基线相比，所有p均小于0.05），且显著高于第2组（37±24、32±16、41±23厘米/秒；与第1组相比所有p均小于0.05）。腺苷和罂粟碱的冠状动脉扩张储备率（计算为充血期与基础平均血流速度之比）在第1组中分别为2.94±1.50和2.94±1.00，在第2组中显著且相似地降低（分别为2.16±0.81和2.38±0.78；与第1组相比，两者p均小于0.05）。低剂量腺苷推注使平均速度增加的幅度与持续输注100微克/千克后的相当，但小于罂粟碱后的增加幅度。腺苷输注与罂粟碱在平均冠状动脉血流速度和冠状动脉扩张储备率方面均存在强相关性（r2分别为0.871和0.325；标准误分别为0.068和0.189；两者p均小于0.0005）。使用腺苷时，无患者出现明显心律失常或校正QT（QTc）间期延长，但罂粟碱使QT（QTc）间期从445±44毫秒增加到501±43毫秒（与最大腺苷剂量和基线相比，p均小于0.001），并在1例患者中诱发了非持续性室性心动过速。（摘要截短于400字）
