天然内乳动脉-冠状动脉旁路的功能及其对心肌缺血的影响。
Function of natural internal mammary-to-coronary artery bypasses and its effect on myocardial ischemia.
机构信息
From the Department of Cardiology, University Hospital, Bern, Switzerland.
出版信息
Circulation. 2014 Jun 24;129(25):2645-52. doi: 10.1161/CIRCULATIONAHA.114.008898. Epub 2014 Apr 17.
BACKGROUND
The function of naturally existing internal mammary (IMA)-to-coronary artery bypasses and their quantitative effect on myocardial ischemia are unknown.
METHODS AND RESULTS
The primary end point of this study was collateral flow index (CFI) obtained during two 1-minute coronary artery balloon occlusions, the first with and the second without simultaneous distal IMA occlusion. The secondary study end point was the quantitatively determined intracoronary ECG ST-segment elevation. CFI is the ratio of simultaneously recorded mean coronary occlusive pressure divided by mean aortic pressure both subtracted by mean central venous pressure. A total of 180 pairs of CFI measurements were performed among 120 patients. With and without IMA occlusion, CFI was 0.110±0.074 and 0.096±0.072, respectively (P<0.0001). The difference of CFI obtained in the presence minus CFI obtained in the absence of IMA occlusion was highest and most consistently positive during left IMA with left anterior descending artery occlusion and during right IMA with right coronary artery occlusion (ipsilateral occlusions): 0.033±0.044 and 0.025±0.027, respectively. This CFI difference was absent during right IMA with left anterior descending artery occlusion and during left IMA with right coronary artery occlusion (contralateral occlusions): -0.007±0.034 and 0.001±0.023, respectively (P=0.0002 versus ipsilateral occlusions). The respective CFI differences during either IMA with left circumflex artery occlusion were inconsistently positive. Intracoronary ECG ST-segment elevations were significantly reduced during ipsilateral IMA occlusions but not during contralateral or left circumflex artery occlusions.
CONCLUSION
There is a functional, ischemia-reducing extracardiac coronary artery supply via ipsilateral but not via contralateral natural IMA bypasses.
CLINICAL TRIAL REGISTRATION URL
http://www.clinicaltrials.gov. Unique identifier: NCTO1676207.
背景
自然存在的内乳动脉（IMA）至冠状动脉旁路的功能及其对心肌缺血的定量影响尚不清楚。
方法和结果
本研究的主要终点是在两次 1 分钟的冠状动脉球囊闭塞期间获得的侧支血流指数（CFI），第一次伴有和第二次不伴有同时的远端 IMA 闭塞。次要研究终点是定量确定的冠状动脉内 ECG ST 段抬高。CFI 是同时记录的平均冠状动脉闭塞压除以平均主动脉压，两者均减去平均中心静脉压。在 120 名患者中总共进行了 180 对 CFI 测量。在存在和不存在 IMA 闭塞的情况下，CFI 分别为 0.110±0.074 和 0.096±0.072（P<0.0001）。在左 IMA 伴左前降支闭塞和右 IMA 伴右冠状动脉闭塞时，存在 IMA 闭塞时获得的 CFI 减去不存在 IMA 闭塞时获得的 CFI 的差值最大且始终为正（同侧闭塞）：0.033±0.044 和 0.025±0.027，分别。在右 IMA 伴左前降支闭塞和左 IMA 伴右冠状动脉闭塞时，这种 CFI 差异不存在（对侧闭塞）：-0.007±0.034 和 0.001±0.023，分别（与同侧闭塞相比，P=0.0002）。在任一 IMA 伴左回旋支闭塞时，CFI 差异均不一致为正。同侧 IMA 闭塞时，冠状动脉内 ECG ST 段抬高明显减少，但对侧或左回旋支闭塞时则不然。
结论
存在通过同侧而非对侧天然 IMA 旁路的功能性、减少缺血的心脏外冠状动脉供应。
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