Heart Institute, Hospital das Clínicas, da Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
Clinics (Sao Paulo). 2009;64(4):327-35. doi: 10.1590/s1807-59322009000400011.
We evaluated the impairment of endothelium-dependent and endothelium-independent coronary blood flow reserve after administration of intracoronary acetylcholine and adenosine, and its association with hypertensive cardiac disease.
Coronary blood flow reserve reduction has been proposed as a mechanism for the progression of compensated left ventricular hypertrophy to ventricular dysfunction.
Eighteen hypertensive patients with normal epicardial coronary arteries on angiography were divided into two groups according to left ventricular fractional shortening (FS). Group 1 (FS > or =0.25): n=8, FS=0.29 +/- 0.03; Group 2 (FS <0.25): n=10, FS= 0.17 +/- 0.03.
Baseline coronary blood flow was similar in both groups (Group 1: 80.15 +/- 26.41 mL/min, Group 2: 100.09 +/- 21.51 mL/min, p=NS). In response to adenosine, coronary blood flow increased to 265.1 +/- 100.2 mL/min in Group 1 and to 300.8 +/- 113.6 mL/min (p <0.05) in Group 2. Endothelium-independent coronary blood flow reserve was similar in both groups (Group 1: 3.31 +/- 0.68 and Group 2: 2.97 +/- 0.80, p=NS). In response to acetylcholine, coronary blood flow increased to 156.08 +/- 36.79 mL/min in Group 1 and to 177.8 +/- 83.6 mL/min in Group 2 (p <0.05). Endothelium-dependent coronary blood flow reserve was similar in the two groups (Group 1: 2.08 +/- 0.74 and group Group 2: 1.76 +/- 0.61, p=NS). Peak acetylcholine/peak adenosine coronary blood flow response (Group 1: 0.65 +/- 0.27 and Group 2: 0.60 +/- 0.17) and minimal coronary vascular resistance (Group 1: 0.48 +/- 0.21 mmHg/mL/min and Group 2: 0.34 +/- 0.12 mmHg/mL/min) were similar in both groups (p= NS). Casual diastolic blood pressure and end-systolic left ventricular stress were independently associated with FS.
In our hypertensive patients, endothelium-dependent and endothelium-independent coronary blood flow reserve vasodilator administrations had similar effects in patients with either normal or decreased left ventricular systolic function.
评估冠状动脉内给予乙酰胆碱和腺苷后内皮依赖性和非内皮依赖性冠状动脉血流储备的损害，并探讨其与高血压性心脏病的关系。
冠状动脉血流储备降低已被提出作为左心室代偿性肥厚进展为心室功能障碍的机制。
18 例经血管造影证实有正常心外膜冠状动脉的高血压患者根据左心室短轴缩短率（FS）分为两组。组 1（FS≥0.25）：n=8，FS=0.29±0.03；组 2（FS＜0.25）：n=10，FS=0.17±0.03。
两组的基础冠状动脉血流相似（组 1：80.15±26.41mL/min，组 2：100.09±21.51mL/min，p=NS）。在给予腺苷后，组 1 的冠状动脉血流增加至 265.1±100.2mL/min，组 2 增加至 300.8±113.6mL/min（p＜0.05）。两组的非内皮依赖性冠状动脉血流储备相似（组 1：3.31±0.68，组 2：2.97±0.80，p=NS）。在给予乙酰胆碱后，组 1 的冠状动脉血流增加至 156.08±36.79mL/min，组 2 增加至 177.8±83.6mL/min（p＜0.05）。两组的内皮依赖性冠状动脉血流储备相似（组 1：2.08±0.74，组 2：1.76±0.61，p=NS）。乙酰胆碱/腺苷最大冠状动脉血流反应（组 1：0.65±0.27，组 2：0.60±0.17）和最小冠状动脉血管阻力（组 1：0.48±0.21mmHg/mL/min，组 2：0.34±0.12mmHg/mL/min）在两组中相似（p=NS）。偶然的舒张压和收缩末期左心室压力与 FS 独立相关。
在我们的高血压患者中，内皮依赖性和非内皮依赖性冠状动脉血流储备扩张剂的作用在左心室收缩功能正常或降低的患者中相似。
