Tsagalou Eleftheria P, Anastasiou-Nana Maria, Agapitos Emmanuel, Gika Apostolia, Drakos Stavros G, Terrovitis John V, Ntalianis Argirios, Nanas John N
Third Cardiology Department, University of Athens School of Medicine, Athens, Greece.
J Am Coll Cardiol. 2008 Oct 21;52(17):1391-8. doi: 10.1016/j.jacc.2008.05.064.
We sought to examine the relationship between coronary flow reserve (CFR) and myocardial capillary density (MCD) in patients with idiopathic dilated cardiomyopathy, heart failure, and normal coronary arteries.
Coronary flow reserve is depressed in patients with idiopathic dilated cardiomyopathy, particularly in those with end-stage congestive heart failure.
We studied 18 patients, 48 +/- 10 years of age, who had a mean New York Heart Association functional class of 2.9 +/- 1.3, mean left ventricular ejection fraction of 22 +/- 8%, and mean pulmonary capillary wedge pressure of 23 +/- 10 mm Hg. CFR measurements were made with a 0.014-inch pressure-temperature sensor-tipped guide wire placed in the distal left anterior descending coronary artery. Thermodilution curves were constructed in triplicate at baseline and during maximum hyperemia induced by intravenous adenosine. CFR was calculated from the ratio of mean transit times. Right heart endomyocardial biopsies were performed during the same procedure. Autopsied specimens from nonfailing hearts were used as controls. The tissue was histochemically stained with CD-34 for morphometric measurements of MCD.
We observed a close linear relationship between CFR and MCD (r = 0.756, p = 0.0001). The MCD in 7 patients with a CFR >or=2.5 (73.2 +/- 16) was similar to that measured in normal control patients, (85 +/- 11, p = NS). In contrast, the MCD in 11 patients with a CFR <2.5 was 33.2 +/- 14, which was significantly lower than in patients with heart failure and normal CFR (73.2 +/- 16, p = 0.001) or in controls (85 +/- 11, p < 0.0001).
A marked decrease in MCD was found in patients presenting with congestive heart failure as the result of idiopathic dilated cardiomyopathy and a depressed CFR.
我们试图研究特发性扩张型心肌病、心力衰竭且冠状动脉正常的患者的冠状动脉血流储备（CFR）与心肌毛细血管密度（MCD）之间的关系。
特发性扩张型心肌病患者，尤其是终末期充血性心力衰竭患者的冠状动脉血流储备降低。
我们研究了18例年龄为48±10岁的患者，其纽约心脏协会心功能分级平均为2.9±1.3，左心室射血分数平均为22±8%，肺毛细血管楔压平均为23±10 mmHg。使用置于左前降支冠状动脉远端的0.014英寸压力 - 温度传感器导丝进行CFR测量。在基线时以及静脉注射腺苷诱导最大充血期间，重复三次构建热稀释曲线。CFR由平均通过时间的比值计算得出。在同一操作过程中进行右心内膜心肌活检。来自非衰竭心脏的尸检标本用作对照。组织用CD - 34进行组织化学染色以测量MCD的形态学指标。
我们观察到CFR与MCD之间存在密切的线性关系（r = 0.756，p = 0.0001）。7例CFR≥2.5的患者的MCD（73.2±16）与正常对照患者测量的MCD相似（85±11，p = 无显著性差异）。相比之下，11例CFR＜2.5的患者的MCD为33.2±14，显著低于心力衰竭且CFR正常的患者（73.2±16，p = 0.001）或对照组（85±11，p＜0.0001）。
在因特发性扩张型心肌病和CFR降低而出现充血性心力衰竭的患者中发现MCD显著降低。
