Hess O M, Bortone A, Eid K, Gage J E, Nonogi H, Grimm J, Krayenbuehl H P
Department of Internal Medicine, University Hospital, Zurich, Switzerland.
Eur Heart J. 1989 Nov;10 Suppl F:105-10. doi: 10.1093/eurheartj/10.suppl_f.105.
Coronary vasomotion is an important determinant of myocardial perfusion in patients with angina pectoris, and it influences not only normal but also stenotic coronary arteries. The ability of a stenotic coronary artery to change its size is dependent on the presence of a normal musculo-elastic wall segment within the stenosis (i.e., eccentric stenosis). Coronary vasoconstriction of normal and stenotic coronary arteries has been reported by Brown and coworkers (Circulation 1984; 70: 18-24) during isometric exercise. The effect of dynamic exercise on coronary vasomotion was evaluated in one group of 13 patients with ischaemia-like symptoms and normal coronary arteries (group 1) and in a second group of 12 patients with coronary artery disease with exercise-induced angina pectoris (group 2). Luminal area of a normal and a stenotic vessel segment was determined by biplane quantitative coronary arteriography at rest, during supine bicycle exercise and 5 min after administration of 1.6 mg sublingual nitroglycerin. Coronary sinus blood flow was measured in group 1 at rest and after 0.5 mg kg-1 intravenous dipyridamole using coronary sinus thermodilution. Coronary flow reserve was calculated from coronary sinus flow after dipyridamole divided by coronary sinus flow at rest. In group 1, coronary vasodilation of the large (i.e., proximal) and the small (i.e., distal) coronary arteries was observed during exercise in seven patients (subgroup A). However, in the remaining six patients (subgroup B) coronary vasoconstriction of the small arteries (-24%, P less than 0.001) was found during exercise, whereas the large vessels showed coronary vasodilation (+26%, P less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
冠状动脉舒缩运动是心绞痛患者心肌灌注的重要决定因素，它不仅影响正常冠状动脉，也影响狭窄冠状动脉。狭窄冠状动脉改变其大小的能力取决于狭窄部位正常肌肉弹性壁段的存在（即偏心性狭窄）。Brown及其同事报道，等长运动期间正常和狭窄冠状动脉会发生冠状动脉收缩（《循环》1984年；70: 18 - 24）。对一组13例有缺血样症状且冠状动脉正常的患者（第1组）和另一组12例有运动诱发心绞痛的冠心病患者（第2组），评估动态运动对冠状动脉舒缩运动的影响。在静息状态、仰卧位自行车运动期间及舌下含服1.6 mg硝酸甘油后5分钟，通过双平面定量冠状动脉造影确定正常和狭窄血管段的管腔面积。在第1组中，静息状态及静脉注射0.5 mg/kg双嘧达莫后，使用冠状窦热稀释法测量冠状窦血流量。冠状动脉血流储备通过双嘧达莫后冠状窦血流量除以静息状态下冠状窦血流量来计算。在第1组中，7例患者（A亚组）运动期间观察到大小（即近端和远端）冠状动脉均有血管舒张。然而，其余6例患者（B亚组）运动期间发现小动脉有血管收缩（-24%，P<0.001），而大血管显示血管舒张（+26%，P<0.001）。（摘要截短于250字）
