Sampietro Tiziana, Sbrana Francesco, Pasanisi Emilio Maria, Bigazzi Federico, Petersen Christina, Coceani Michele, Dal Pino Beatrice, Ripoli Andrea, Pianelli Mascia, Luciani Roberta
Fondazione Toscana Gabriele Monasterio, Pisa, Italy.
Fondazione Toscana Gabriele Monasterio, Pisa, Italy.
Atheroscler Suppl. 2017 Nov;30:135-140. doi: 10.1016/j.atherosclerosissup.2017.05.038. Epub 2017 Jun 1.
LDL apheresis (LA) influences the microcirculation, endothelial function and cardiovascular homeostasis. The aim of our study was to analyze temporal variations of coronary flow reserve (CFR) on the left anterior descending artery, obtained during dipyridamole stress echocardiography (DSE), in patients with severe familial hypercholesterolemia on LA (LA group) or not (not LA group) and ischemic heart disease (IHD).
The LA group consisted in 10 patients (mean age 65 ± 7 years, male 70%) with Familial Hypercholesterolemia and chronic IHD on maximally tolerated lipid lowering therapy and chronic LA treatment (median 7 years, interquartile range 6-14 years). Hyperlipoproteinemia (a) was also present in 6/10 subjects. LA was performed biweekly by dextran-sulfate or heparin-induced LDL precipitation technique. IHD was diagnosed at a mean age of 44 ± 8 years. The control group was matched for age, sex and follow-up period. CFR was calculated as the ratio between blood diastolic velocity sampled at peak stress with dipyridamole and baseline diastolic velocity (normal value > 2.0). No relevant comorbidities were present.
During a median follow-up of 27 months (interquartile range 23-50 months), a significant increase in CFR (from 1.86 ± 0.47 to 2.25 ± 0.35; p < 0.001) was observed in LA group. During this period, no patients modified their anti-ischemic therapy and no cardiovascular events were reported. In the control group, during the study time (24 months - interquartile range 14-57 months) no significant variation in CFR was observed (from 2.08 ± 0.39 to 1.92 ± 0.26; p 0.283).
Myocardial blood perfusion, measured as CFR by dipyridamole stress echocardiography-is increased in patients with severe familial hypercholesterolemia chronically treated with LA. DSE might be a reliable tool to monitor the therapeutic effect of lipid lowering therapy.
低密度脂蛋白分离术（LA）会影响微循环、内皮功能和心血管稳态。我们研究的目的是分析在双嘧达莫负荷超声心动图（DSE）期间获得的左前降支冠状动脉血流储备（CFR）的时间变化，研究对象为接受LA治疗（LA组）或未接受LA治疗（非LA组）的严重家族性高胆固醇血症患者以及缺血性心脏病（IHD）患者。
LA组包括10例患者（平均年龄65±7岁，男性占70%），患有家族性高胆固醇血症和慢性IHD，接受最大耐受的降脂治疗和慢性LA治疗（中位数7年，四分位间距6 - 14年）。6/10的受试者还存在高脂蛋白血症（a）。通过右旋糖酐硫酸酯或肝素诱导的LDL沉淀技术每两周进行一次LA。IHD诊断时的平均年龄为44±8岁。对照组在年龄、性别和随访时间上相匹配。CFR计算为双嘧达莫负荷峰值时采集的舒张期血流速度与基线舒张期血流速度之比（正常值>2.0）。不存在相关合并症。
在中位随访27个月（四分位间距23 - 50个月）期间，LA组的CFR显著增加（从1.86±0.47增至2.25±0.35；p<0.001）。在此期间，没有患者改变其抗缺血治疗，也未报告心血管事件。在对照组中，在研究期间（24个月 - 四分位间距14 - 57个月）未观察到CFR有显著变化（从2.08±0.39降至1.92±0.26；p = 0.283）。
对于长期接受LA治疗的严重家族性高胆固醇血症患者，通过双嘧达莫负荷超声心动图测量的心肌血流灌注即CFR会增加。DSE可能是监测降脂治疗效果的可靠工具。
