Terashima S, Nakamura T, Furukawa K, Kawata K, Azuma A, Matsubara K, Onishi K, Shiga K, Tatsukawa H, Sugihara H
Second Department of Medicine, Kyoto Prefectural University of Medicine.
Kokyu To Junkan. 1991 Feb;39(2):169-74.
Pathophysiology and clinical significance of a systolic backward flow in the epicardial coronary artery have not been elucidated. Using a 20 MHz Doppler catheter, we assessed coronary flow velocity waveforms in the left anterior descending coronary artery in 19 patients with hypertrophic cardiomyopathy (HCM) and 11 patients without apparent cardiac abnormalities as control subjects. Systolic flow fraction was smaller in HCM than in controls. Only 4 patients with HCM showed a prominent retrograde flow persisting during almost the entire systole. All the 4 had marked cavity obliteration and two of them had systolic intraventricular pressure gradients of 80 and 110 mmHg respectively. Exercise thallium-201 ECT revealed that myocardial hypoperfusion was more frequent in those 4 patients. Through these observations, it is concluded that a high intramyocardial systolic pressure combined with a relatively low coronary perfusing pressure may result in a large systolic retrograde flow in the left epicardial coronary artery, and that it may be related to myocardial ischemia in patients with HCM.
心外膜冠状动脉收缩期逆向血流的病理生理学及临床意义尚未阐明。我们使用20MHz多普勒导管，评估了19例肥厚型心肌病（HCM）患者及11例无明显心脏异常的对照者左前降支冠状动脉的血流速度波形。HCM患者的收缩期血流分数低于对照组。仅4例HCM患者在几乎整个收缩期均出现明显的逆向血流。这4例患者均有明显的心腔闭塞，其中2例患者的收缩期心室内压力阶差分别为80mmHg和110mmHg。运动铊-201心肌显像显示，这4例患者心肌灌注不足更为常见。通过这些观察结果得出结论，心肌内收缩期高压与相对较低的冠状动脉灌注压相结合，可能导致心外膜左冠状动脉出现较大的收缩期逆向血流，且这可能与HCM患者的心肌缺血有关。
