Macdonald R G, Hill J A, Feldman R L
Circulation. 1986 Nov;74(5):973-9. doi: 10.1161/01.cir.74.5.973.
To assess the relationship between the direction of ST segment response to transient coronary occlusion and collateral function, we studied 25 patients with diagnostic ST segment changes during transient occlusion of the proximal left anterior descending artery (LAD). Electrocardiographic leads I, II, V2, and V5; left ventricular filling, aortic, and distal coronary pressures; and great cardiac vein flow were measured during percutaneous transluminal coronary angioplasty (PTCA) of the LAD. During a 1 min LAD balloon occlusion, 16 patients had reversible ST elevation (group I) and nine patients had ST depression (group II). The ST responses in individual patients were consistent during repeated occlusions, and ST depression never preceded ST elevation. Angiography before PTCA showed less severe LAD stenosis in group I (69 +/- 15%) than in group II (88 +/- 10%; p less than .01) and collateral filling of the LAD in no group I patient but in six of nine patients in group II (p less than .01). During LAD occlusion, determinants of myocardial oxygen demand (left ventricular filling pressure, aortic pressure, heart rate, and double product) were similar in both groups. Group I patients, however, had lower distal coronary pressure (25 +/- 8 vs 41 +/- 16 mm Hg) and residual great cardiac vein flow (33 +/- 14 vs 51 +/- 22 ml/min) and higher coronary collateral resistance (3.1 +/- 2.1 vs 1.5 +/- 0.8 mm Hg/ml/min) than group II patients (all p less than .05). In patients with ST elevation during LAD occlusion, stenosis before PTCA was less severe, visible collaterals were not present, and hemodynamic variables during LAD occlusion reflected poorer collateral function.(ABSTRACT TRUNCATED AT 250 WORDS)
为评估ST段对短暂性冠状动脉闭塞的反应方向与侧支循环功能之间的关系，我们研究了25例在左前降支近端（LAD）短暂闭塞期间出现诊断性ST段改变的患者。在LAD经皮腔内冠状动脉成形术（PTCA）期间，测量了心电图导联I、II、V2和V5；左心室充盈压、主动脉压和冠状动脉远端压力；以及冠状大静脉血流。在1分钟的LAD球囊闭塞期间，16例患者出现可逆性ST段抬高（I组），9例患者出现ST段压低（II组）。在重复闭塞期间，个体患者的ST反应是一致的，且ST段压低从未先于ST段抬高出现。PTCA前的血管造影显示，I组的LAD狭窄程度（69±15%）低于II组（88±10%；p<0.01），I组无患者出现LAD侧支循环充盈，而II组9例患者中有6例出现（p<0.01）。在LAD闭塞期间，两组的心肌需氧量决定因素（左心室充盈压、主动脉压、心率和双乘积）相似。然而，I组患者的冠状动脉远端压力（25±8 vs 41±16 mmHg）和冠状大静脉残余血流（33±14 vs 51±22 ml/min）低于II组患者，冠状动脉侧支循环阻力（3.1±2.1 vs 1.5±0.8 mmHg/ml/min）高于II组患者（所有p<0.05）。在LAD闭塞期间出现ST段抬高的患者中，PTCA前的狭窄程度较轻，未见明显侧支循环，LAD闭塞期间的血流动力学变量反映出侧支循环功能较差。（摘要截取自250字）
