Lablanche J M, Bauters C, Leroy F, Bertrand M
Service de cardiologie B et hémodynamique, hôpital Cardiologique, université de Lille II.
Arch Mal Coeur Vaiss. 1991 Jan;84 Spec No 1:69-74.
Provocative testing has provided a method of evaluating the important role of vasomotor tone in coronary artery disease. The most sensitive test is the ergonovine (Methergin) test. This is a specific and reliable method of defining the clinical situations in which coronary spasm is common: --focal coronary artery spasm is mainly observed in resting angina alone or in association with effort angina. The prognosis of spasm is excellent with calcium antagonist therapy provided there is no other associated pathology such as left ventricular failure or triple vessel disease; --in the six weeks following myocardial infarction, focal coronary artery spasm is a common event: 20% of coronary angiographies. After six weeks, spasm is much less frequent. It does not influence the prognosis. This type of spasm is probably related to the scarring process; --coronary artery spasm is frequently associated with restenosis after coronary angioplasty, a process which is histologically related to proliferation of smooth muscle; --diffuse increase in coronary vasomotor tone is a much rarer pathology, perhaps related to global changes in vascular tone as its association with the Raynaud syndrome and with migraine would suggest. It presents clinically with resting angina and sometimes by typical Prinzmetal angina; --finally, vosomotor tone plays an important role in the daily life of coronary patients. Holter recordings for the detection of silent myocardial ischemia have shown episodes of myocardial ischemia at lower myocardial oxygen consumption levels than those usually recorded during exercise stress testing, which suggests a reduction in oxygen supply, that is to say coronary vasoconstriction. Changes in coronary vasomotor tone can modify the diameter of healthy coronary arteries by 100%.(ABSTRACT TRUNCATED AT 250 WORDS)
激发试验提供了一种评估血管舒缩张力在冠状动脉疾病中重要作用的方法。最敏感的试验是麦角新碱（甲基麦角新碱）试验。这是一种明确冠状动脉痉挛常见临床情况的特异且可靠的方法：——局灶性冠状动脉痉挛主要见于单纯静息性心绞痛或合并劳力性心绞痛。若不存在如左心室衰竭或三支血管病变等其他相关病理情况，钙拮抗剂治疗对痉挛的预后极佳；——在心肌梗死后六周内，局灶性冠状动脉痉挛是常见事件：在20%的冠状动脉造影检查中可见。六周后，痉挛发生频率大大降低。它不影响预后。这种类型的痉挛可能与瘢痕形成过程有关；——冠状动脉痉挛常与冠状动脉成形术后再狭窄相关，这一过程在组织学上与平滑肌增殖有关；——冠状动脉血管舒缩张力的弥漫性增加是一种罕见得多的病理情况，可能与血管张力的整体变化有关，因为它与雷诺综合征和偏头痛相关。其临床表现为静息性心绞痛，有时表现为典型的变异型心绞痛；——最后，血管舒缩张力在冠心病患者的日常生活中起重要作用。用于检测无症状心肌缺血的动态心电图记录显示，心肌缺血发作时的心肌氧消耗水平低于运动负荷试验通常记录的水平，这提示氧供应减少，即冠状动脉血管收缩。冠状动脉血管舒缩张力的变化可使健康冠状动脉的直径改变100%。（摘要截选至250词）
