Zijlstra F, Reiber J H, Serruys P W
Catheterization Laboratory, Erasmus University, Rotterdam, The Netherlands.
Cathet Cardiovasc Diagn. 1988;14(1):1-6. doi: 10.1002/ccd.1810140102.
Intracoronary papaverine is used as a means to induce a strong and short-lasting hyperemia in several recently developed methods to measure coronary flow reserve. Changes in stenosis geometry from papaverine would influence the measured coronary flow reserve. Therefore, we investigated the influence of intracoronary papaverine on stenosis geometry with quantitative analysis of the coronary angiogram and assessed the influence of papaverine on pressure-flow characteristics of the stenosis and coronary flow reserve. The cross-sectional areas (mean +/- SD) of the stenosis increased 18% +/- 7% after papaverine. The normal proximal and distal parts of the coronary artery dilated 5% +/- 2% after papaverine. This results in a decrease of the calculated pressure drop over the stenosis varying from 20% to 30%. Coronary flow reserve of a flow-limiting epicardial stenosis is overestimated by 16% when papaverine is used to induce hyperemia. These papaverine-induced changes can nevertheless be circumvented by maximal vasodilation of the major epicardial coronary artery with 3 mg intracoronary isosorbidedinitrate prior to the investigation of the coronary flow reserve with papaverine.
在最近开发的几种测量冠状动脉血流储备的方法中，冠状动脉内注射罂粟碱被用作诱导强烈且短暂性充血的一种手段。罂粟碱引起的狭窄几何形状变化会影响所测量的冠状动脉血流储备。因此，我们通过冠状动脉造影的定量分析研究了冠状动脉内注射罂粟碱对狭窄几何形状的影响，并评估了罂粟碱对狭窄压力-流量特性和冠状动脉血流储备的影响。注射罂粟碱后，狭窄的横截面积（平均值±标准差）增加了18%±7%。冠状动脉的正常近端和远端在注射罂粟碱后扩张了5%±2%。这导致计算得出的跨狭窄压力降降低了20%至30%。当使用罂粟碱诱导充血时，限流性心外膜狭窄的冠状动脉血流储备被高估了16%。然而，在使用罂粟碱研究冠状动脉血流储备之前，通过冠状动脉内注射3毫克硝酸异山梨酯使主要心外膜冠状动脉最大程度血管扩张，可以规避这些罂粟碱引起的变化。
