Lario Fabio C, Miname Marcio H, Tsutsui Jeane M, Santos Raul D, Kowatsch Ingrid, Sbano João C N, Ramires Jose A F, Kalil Filho Roberto, Mathias Wilson
Echocardiography Laboratory, Heart Institute, InCor, University of São Paulo Medical School, São Paulo, Brazil.
Echocardiography. 2013 Jan;30(1):64-71. doi: 10.1111/j.1540-8175.2012.01810.x. Epub 2012 Sep 7.
Hypercholesterolemia induces early microcirculatory functional and structural alterations that are reversible by cholesterol reduction. Real time myocardial contrast echocardiography (RTMCE) and vascular ultrasound evaluate the effects of hyperlipidemia on peripheral and central blood flow reserve. This study investigated the effects of lipid-lowering therapy on coronary and peripheral artery circulation in patients with familial hypercholesterolemia (FH).
RTMCE and vascular ultrasound were performed in 10 healthy volunteers (validation group) at baseline and after 12-week clinical observation, and in 16 age- and sex-matched FH patients without obstructive coronary artery disease (CAD) by computed tomography angiography at baseline and after 12-week atorvastatin treatment. Indexes of relative myocardial blood flow (MBF) were obtained at rest and during adenosine infusion.
In validation group, there was no significant difference between flow-mediated dilation (FMD) at baseline and after 12 weeks (0.15 ± 0.02 vs. 0.14 ± 0.03; P = 0.39). Similarly, no differences were observed in MBF reserve at baseline and after 12 weeks (3.31 ± 0.63 vs. 3.48 ± 0.89; P = 0.89). FMD was blunted in FH patients, at baseline, as compared with validation group (0.08 ± 0.04 vs. 0.15 ± 0.02; P < 0.001) and became similar to that group (0.13 ± 0.05 vs. 0.14 ± 0.03; P = 0.07) after treatment. MBF reserve was blunted at baseline in FH patients in comparison with the validation group (2.78 ± 0.71 vs. 3.31 ± 0.63; P = 0.003). After treatment, MBF reserve values were no longer different (3.43 ± 0.66 and 3.48 ± 0.89; P = 0.84, respectively, for FH and validation groups).
Patients with FH and no obstructive CAD have blunted MBF reserve and lower FMD values as compared with healthy volunteers. Both FMD and MBF reserve were normalized after atorvastatin treatment.
高胆固醇血症会引发早期微循环功能和结构改变，降低胆固醇可使其逆转。实时心肌造影超声心动图（RTMCE）和血管超声可评估高脂血症对外周和中心血流储备的影响。本研究调查了降脂治疗对家族性高胆固醇血症（FH）患者冠状动脉和外周动脉循环的影响。
对10名健康志愿者（验证组）在基线时和12周临床观察后进行RTMCE和血管超声检查，对16名年龄和性别匹配、无阻塞性冠状动脉疾病（CAD）的FH患者在基线时和接受12周阿托伐他汀治疗后通过计算机断层扫描血管造影进行检查。在静息状态和静脉注射腺苷期间获取相对心肌血流量（MBF）指标。
在验证组中，基线时和12周后的血流介导的血管舒张（FMD）无显著差异（0.15±0.02对0.14±0.03；P = 0.39）。同样，基线时和12周后的MBF储备也无差异（3.31±0.63对3.48±0.89；P = 0.89）。与验证组相比，FH患者在基线时FMD减弱（0.08±0.04对0.15±0.02；P < 0.001），治疗后与该组相似（0.13±0.05对0.14±0.03；P = 0.07）。与验证组相比，FH患者在基线时MBF储备减弱（2.78±0.71对3.31±0.63；P = 0.003）。治疗后，MBF储备值不再有差异（FH组和验证组分别为3.43±0.66和3.48±0.89；P = 0.84）。
与健康志愿者相比，无阻塞性CAD的FH患者MBF储备减弱且FMD值较低。阿托伐他汀治疗后，FMD和MBF储备均恢复正常。
