de Bruyne B, Meier B, Finci L, Urban P, Rutishauser W
Cardiology Center, University Hospital, Geneva, Switzerland.
Circulation. 1988 Sep;78(3):566-72. doi: 10.1161/01.cir.78.3.566.
To assess the potential of coronary collateral circulation to protect myocardium after occlusion of a coronary vessel, the mean coronary wedge pressure, the angiographic grade of collateral channels, and the left ventricular function were studied in 47 consecutive patients with mechanical recanalization of totally occluded coronary arteries. Coronary wedge pressure measurements were obtained 39 +/- 51 days (range, 2 hours to 361 days) after the presumed time of occlusion. The patients were divided into two groups: 31 with a coronary wedge pressure more than 30 mm Hg (group 1) and 16 with a coronary wedge pressure of or less than 30 mm Hg (group 2). Patients in group 1 had a significantly higher mean global left ventricular ejection fraction than those in group 2 (63 +/- 9% vs. 49 +/- 7%, p less than 0.001). Regional left ventricular function (artery-related area change) was also superior in group 1 compared with group 2 (47 +/- 11% vs. 36 +/- 10%, p less than 0.01). Global left ventricular function was significantly correlated to coronary wedge pressure (r = 0.51, p less than 0.001) but not to the angiographic presence of collaterals. The data suggest that a high coronary wedge pressure is associated with improved left ventricular function after coronary artery occlusion and that coronary wedge pressure more accurately reflects the physiological role of collaterals than their angiographic presence.
为评估冠状动脉闭塞后冠状侧支循环保护心肌的潜力，对47例接受完全闭塞冠状动脉机械再通术的连续患者进行了平均冠状动脉楔压、侧支血管造影分级及左心室功能的研究。在推测的冠状动脉闭塞时间后39±51天（范围2小时至361天）测量冠状动脉楔压。患者被分为两组：31例冠状动脉楔压大于30 mmHg的患者为第1组，16例冠状动脉楔压小于或等于30 mmHg的患者为第2组。第1组患者的平均左心室整体射血分数显著高于第2组（63±9%对49±7%，p<0.001）。与第2组相比，第1组的局部左心室功能（动脉相关区域变化）也更优（47±11%对36±10%，p<0.01）。左心室整体功能与冠状动脉楔压显著相关（r = 0.51，p<0.001），但与侧支血管造影显示情况无关。数据表明，冠状动脉闭塞后，高冠状动脉楔压与左心室功能改善相关，且冠状动脉楔压比侧支血管造影显示情况更准确地反映侧支循环的生理作用。
