不对称性肥厚型心肌病患者的微循环区域性差异：经胸多普勒冠状动脉血流储备分析。

Regional difference of microcirculation in patients with asymmetric hypertrophic cardiomyopathy: transthoracic Doppler coronary flow velocity reserve analysis.

机构信息

Clinic for Cardiology, Clinical Center of Serbia, Belgrade, Serbia.

出版信息

J Am Soc Echocardiogr. 2013 Jul;26(7):775-82. doi: 10.1016/j.echo.2013.03.023. Epub 2013 May 2.

DOI:10.1016/j.echo.2013.03.023

PMID:23643850

Abstract

OBJECTIVE

To evaluate, by noninvasive coronary flow velocity reserve (CFVR), whether patients with asymmetric hypertrophic cardiomyopathy (HC), with or without left ventricular outflow tract obstruction, demonstrate significant regional differences of CFVR.

METHODS

We evaluated 61 patients with HC (27 men; mean age 49 ± 16 years), including 20 patients with hypertrophic obstructive cardiomyopathy (HOCM) and 41 patients without obstruction (HCM). The control group included 20 age- and sex-matched subjects. Transthoracic Doppler echocardiography CFVR of the left anterior descending coronary artery (LAD) and the posterior descending coronary artery (PD) were performed, including calculation of relative CFVR as the ratio between CFVR LAD and CFVR PD.

RESULTS

Compared with the controls, all the patients with HC had lower CFVR LAD (2.12 ± 0.53 vs 3.34 ± 0.67; P < .001) and CFVR PD (2.29 ± 0.49 vs 3.21 ± 0.65; P < .001). CFVR LAD in HOCM group in comparison with the HCM group was significantly lower (1.93 ± 0.42 vs 2.22 ± 0.55; P = .047), due to higher basal diastolic coronary flow velocities (0.40 ± 0.09 vs 0.33 ± 0.07 m/sec; P = .002), with similar hyperemic diastolic flow velocities (0.71 ± 0.16 vs 0.76 ± 0.19 m/sec; P = .330), respectively. There was no significant difference in CFVR PD between patients with HOCM and those with HCM (2.33 ± 0.46 vs 2.27 ± 0.50; P = .636), respectively. Relative CFVR was lower in the HOCM group compared with the HCM group (0.84 ± 0.16 vs 0.98 ± 0.14; P = .001). By multivariable regression analysis, left ventricular outflow tract gradient was the independent predictor of CFVR LAD (B = -0.24; P = .008) and relative CFVR (B = -0.34; P = .016).

CONCLUSIONS

CFVR LAD and relative CFVR were significantly lower in patients with HOCM compared with patients with HCM. Regional differences of CFVR are present only in patients with significant left ventricular outflow tract obstruction, which suggests that obstruction per se, by increasing wall stress in basal conditions, leads to higher basal diastolic coronary flow velocities and results in lower CFVR in LAD compared with PD.

摘要

目的

通过非侵入性冠状动脉血流储备（CFVR）评估有无左心室流出道梗阻的不对称性肥厚型心肌病（HC）患者是否存在 CFVR 的显著区域性差异。

方法

我们评估了 61 名 HC 患者（27 名男性；平均年龄 49 ± 16 岁），包括 20 名肥厚型梗阻性心肌病（HOCM）患者和 41 名无梗阻（HCM）患者。对照组包括 20 名年龄和性别匹配的受试者。通过经胸多普勒超声心动图测量左前降支（LAD）和后降支（PD）的 CFVR，并计算 CFVR LAD 与 CFVR PD 的相对 CFVR。

结果

与对照组相比，所有 HC 患者的 LAD CFVR（2.12 ± 0.53 对 3.34 ± 0.67；P <.001）和 PD CFVR（2.29 ± 0.49 对 3.21 ± 0.65；P <.001）均较低。与 HCM 组相比，HOCM 组的 LAD CFVR 明显较低（1.93 ± 0.42 对 2.22 ± 0.55；P =.047），这是由于基础舒张期冠状动脉血流速度较高（0.40 ± 0.09 对 0.33 ± 0.07 m/sec；P =.002），而充血性舒张期血流速度相似（0.71 ± 0.16 对 0.76 ± 0.19 m/sec；P =.330）。HOCM 组与 HCM 组的 PD CFVR 无显著差异（2.33 ± 0.46 对 2.27 ± 0.50；P =.636）。HOCM 组的相对 CFVR 较 HCM 组低（0.84 ± 0.16 对 0.98 ± 0.14；P =.001）。多变量回归分析显示，左心室流出道梯度是 LAD CFVR（B = -0.24；P =.008）和相对 CFVR（B = -0.34；P =.016）的独立预测因子。