Evola Salvatore, Cuttitta Francesco, Evola Giovanna, Macaione Francesca, Piraino Davide, Meschisi Maria Cristina, Peritore Angelica, Di Lisi Daniela, Novo Guiseppina, Novo Salvatore
Division and Post-Graduate School of Cardiology, Center for the Early Diagnosis of Preclinical and Multifocal Atherosclerosis and for the Secondary Prevention, University Hospital "P. Giaccone" of the University of Palermo, Italy.
Intern Med. 2012;51(13):1653-60. doi: 10.2169/internalmedicine.51.7385. Epub 2012 Jul 1.
In hypertensive patients with typical chest pain but absence of coronary stenosis the coronary microcirculation may be impaired, thus, our study aimed to appraise, in these subjects, the role of the coronary microcirculation, assessed by Myocardial Blush Grade (MBG) and Thrombolysis in Myocardial Infarction (TIMI) Frame Count (TFC).
A total of 95 subjects with chest pain and uninjured coronary arteries were recruited into the study: 80 subjects were hypertensive while 15 subjects were normotensive. The hypertensive subjects were divided into two subgroups: hypertensive subjects with positive scintigraphy and hypertensive subjects with negative scintigraphy. The TFC, a quantitative method of assessing coronary artery flow, the MBG, an assessment of the level of tissue perfusion, and the Total Myocardial Blush Score (TMBS), the sum of the myocardial blush grades of each coronary territory, were evaluated on the coronary angiogram of every patient.
The TFC was higher (p<0.05) in hypertensive subjects than in normotensive subjects. The MBG and the TMBS were lower (p<0.05) in hypertensive subjects than in normotensive subjects. The TFC was higher (p<0.05) in positive scintigraphy than in negative scintigraphy. The MBG was lower (p<0.05) in positive scintigraphy than in negative scintigraphy. The Spearman rank correlation test showed that the TFC and the MBG was inversely associated.
The hypertensive subjects had impaired coronary artery flow and myocardial perfusion, documented by the TFC, MBG and myocardial perfusion scintigraphy. These methods may be universally applicable, in fact they are validated and most catheterization laboratories have access to them.
在有典型胸痛但无冠状动脉狭窄的高血压患者中，冠状动脉微循环可能受损，因此，我们的研究旨在评估这些受试者中冠状动脉微循环的作用，通过心肌 blush 分级（MBG）和心肌梗死溶栓（TIMI）帧数（TFC）进行评估。
总共 95 名有胸痛且冠状动脉未受损的受试者被纳入研究：80 名受试者为高血压患者，15 名受试者为血压正常者。高血压受试者被分为两个亚组：闪烁扫描阳性的高血压受试者和闪烁扫描阴性的高血压受试者。对每位患者的冠状动脉造影评估 TFC（一种评估冠状动脉血流的定量方法）、MBG（一种组织灌注水平评估）以及总心肌 blush 评分（TMBS，每个冠状动脉区域心肌 blush 分级的总和）。
高血压受试者的 TFC 高于血压正常者（p<0.05）。高血压受试者的 MBG 和 TMBS 低于血压正常者（p<0.05）。闪烁扫描阳性者的 TFC 高于闪烁扫描阴性者（p<0.05）。闪烁扫描阳性者的 MBG 低于闪烁扫描阴性者（p<0.05）。Spearman 等级相关检验显示 TFC 与 MBG 呈负相关。
TFC、MBG 和心肌灌注闪烁扫描证明，高血压受试者存在冠状动脉血流和心肌灌注受损。这些方法可能普遍适用，事实上它们已经得到验证，并且大多数导管实验室都可以使用。
