Alihanoglu Yusuf I, Kilic I Dogu, Evrengul Harun, Yildiz Bekir S, Alur Ihsan, Uludag Burcu, Kuru Omur, Taskoylu Ozgur, Kaftan Havane Asuman
Department of Cardiology, Pamukkale University School of Medicine, Denizli, Turkey.
Cardiol J. 2014;21(3):257-64. doi: 10.5603/CJ.a2013.0119. Epub 2013 Aug 30.
The aim of this study is to evaluate heart rate recovery (HRR) and association between coronary flow rate and HRR in patients with metabolic syndrome (MS) who had morphologically normal coronary angiogram.
Study population included 43 patients with MS and 37 control subjects without MS. All patients were selected from individuals who had recently undergone coronary angiography in our hospital and were diagnosed as having angiographically normal coronary arteries. Exercise stress test results obtained prior to coronary angiography were evaluated for calculating HRR and other parameters. In addition, coronary flow was objectively evaluated for each major coronary artery in each subject using TIMI frame count method.
All HRR values calculated were detected significantly lower in MS group compared to controls (HRR first: 32 ± 9 vs. 37 ± 10; p = 0.01, second: 46 ± 11 vs. 52 ± 11; p = 0.03, third: 51 ± 12 vs. 59 ± 12; p = 0.00, fourth: 54 ± 13 vs. 61 ± 2; p = 0.02). TIMI frame counts for each major epicardial coronary artery and mean TIMI frame count were also found to be significantly higher in MS group compared to controls (left anterior descending artery:51 ± 24 vs. 39 ± 15; p = 0.009, left circumflex artery: 32 ± 11 vs. 24 ± 7; p = 0.001, right coronary artery: 33 ± 14 vs. 24 ± 10; p = 0.003, mean TIMI frame count: 38 ± 15 vs. 29 ± 9;p = 0.002). Additionally, significant negative correlations were also detected between HRR first minute and coronary TIMI frame count values in patients with MS. None of MS parameters did not affect HRR values, however mean TIMI frame count independently associated with HRR first minute (p = 0.04) in patients with MS.
Impaired coronary blood flow occurring in MS might be a clue of autonomic dysfunction in addition to previously known endothelial dysfunction.
本研究旨在评估代谢综合征（MS）患者的心率恢复（HRR）情况以及冠状动脉血流速度与HRR之间的关联，这些患者的冠状动脉造影形态正常。
研究人群包括43例MS患者和37例无MS的对照受试者。所有患者均选自我院近期接受冠状动脉造影且被诊断为冠状动脉造影正常的个体。对冠状动脉造影前获得的运动应激试验结果进行评估，以计算HRR和其他参数。此外，使用TIMI帧数法对每个受试者的每条主要冠状动脉的血流进行客观评估。
与对照组相比，MS组计算出的所有HRR值均显著降低（第一分钟HRR：32±9 vs. 37±10；p = 0.01，第二分钟：46±11 vs. 52±11；p = 0.03，第三分钟：51±12 vs. 59±12；p = 0.00，第四分钟：54±13 vs. 61±2；p = 0.02）。与对照组相比，MS组每条主要心外膜冠状动脉的TIMI帧数以及平均TIMI帧数也显著更高（左前降支动脉：51±24 vs. 39±15；p = 0.009，左旋支动脉：32±11 vs. 24±7；p = 0.001，右冠状动脉：33±14 vs. 24±10；p = 0.003，平均TIMI帧数：38±15 vs. 29±9；p = 0.002）。此外，在MS患者中，第一分钟HRR与冠状动脉TIMI帧数之间也检测到显著的负相关。MS的各项参数均未影响HRR值，然而在MS患者中，平均TIMI帧数与第一分钟HRR独立相关（p = 0.04）。
MS中发生的冠状动脉血流受损可能是自主神经功能障碍的一个线索，此外还有先前已知的内皮功能障碍。
