Recio-Mayoral Alejandro, Mason Justin C, Kaski Juan C, Rubens Michael B, Harari Olivier A, Camici Paolo G
Medical Research Council Clinical Sciences Centre and National Heart and Lung Institute, Imperial College School of Medicine, London W12 0NN, UK.
Eur Heart J. 2009 Aug;30(15):1837-43. doi: 10.1093/eurheartj/ehp205. Epub 2009 Jun 5.
To demonstrate that exposure to chronic inflammation results in coronary microvascular dysfunction (CMD).
Using positron emission tomography, resting and hyperaemic (adenosine, 140 microg/kg/min) myocardial blood flow (MBF) was measured in 25 patients with systemic lupus erythematosus (SLE) or rheumatoid arthritis (RA). Coronary flow reserve (CFR) was calculated as adenosine/resting MBF. Patients had normal or minimally diseased (i.e. <or=20% luminal diameter) coronary arteries at angiography and no cardiovascular risk factors. Twenty five age- and gender-matched healthy volunteers served as controls. Resting MBF was similar in patients and controls (1.25 +/- 0.27 vs. 1.15 +/- 0.24 mL/min/g; P = 0.15) while patients had lower hyperaemic MBF (2.94 +/- 0.83 vs. 4.11 +/- 0.84 mL/min/g; P < 0.001) and CFR (2.44 +/- 0.78 vs. 3.81 +/- 1.07; P < 0.001). CFR was inversely related to disease duration (r = -0.65; P < 0.001) and SLE disease activity (r = -0.69; P = 0.01). Seven patients showed ischaemic electrocardiographic changes during adenosine. They had longer disease duration (21 +/- 7 vs. 14 +/- 5 years; P = 0.03) and lower CFR (1.76 +/- 0.81 vs. 2.49 +/- 0.54; P = 0.006) when compared with patients without changes.
A reduced CFR in the absence of significant coronary disease is suggestive of CMD. We speculate that this is the consequence of prolonged systemic inflammation, which may precede and contribute to premature coronary artery disease in these patients.
证明长期暴露于慢性炎症会导致冠状动脉微血管功能障碍（CMD）。
采用正电子发射断层扫描技术，对25例系统性红斑狼疮（SLE）或类风湿关节炎（RA）患者静息和充血（腺苷，140微克/千克/分钟）状态下的心肌血流量（MBF）进行测量。冠状动脉血流储备（CFR）计算为腺苷/静息MBF。患者在血管造影时冠状动脉正常或病变轻微（即管腔直径≤20%）且无心血管危险因素。25名年龄和性别匹配的健康志愿者作为对照。患者和对照组的静息MBF相似（1.25±0.27对1.15±0.24毫升/分钟/克；P = 0.15），而患者的充血MBF较低（2.94±0.83对4.11±0.84毫升/分钟/克；P < 0.001），CFR也较低（2.44±0.78对3.81±1.07；P < 0.001）。CFR与疾病持续时间呈负相关（r = -0.65；P < 0.001），与SLE疾病活动度呈负相关（r = -0.69；P = 0.01）。7例患者在腺苷注射期间出现缺血性心电图改变。与未出现改变的患者相比，他们的疾病持续时间更长（21±7对14±5年；P = 0.03），CFR更低（1.76±0.81对2.49±0.54；P = 0.006）。
在无明显冠状动脉疾病的情况下CFR降低提示CMD。我们推测这是长期全身炎症的结果，这种炎症可能在这些患者的冠状动脉疾病发生之前出现并促使其过早发生。
