Deanfield J E, Shea M J, Wilson R A, Horlock P, de Landsheere C M, Selwyn A P
Am J Cardiol. 1986 May 1;57(13):1005-9. doi: 10.1016/0002-9149(86)90665-x.
Cigarette smoking is strongly associated with ischemic heart disease and acute coronary events. The effect of smoking a single cigarette on regional myocardial perfusion was studied in 13 chronic smokers with typical stable angina pectoris using positron emission tomography and rubidium-82 (82Rb). Findings were compared with the effects of physical exercise. After exercise, 8 patients (61%) had angina, ST depression and abnormal regional myocardial perfusion. Uptake of 82Rb increased from 49 +/- 8 to 60 +/- 7 in remote myocardium, but decreased from 46 +/- 3 to 37 +/- 5 in an ischemic area. The remaining 5 patients (39%) had homogeneous increases in 82Rb uptake without angina or ST depression. After smoking, 6 of the 8 patients with positive exercise test responses had a decrease in 82Rb uptake, from 47 +/- 3 to 35 +/- 6 in the same segment of myocardium affected during exercise. However, in contrast to exercise, the events during smoking were largely silent. The absolute decreases in regional 82Rb uptake after smoking occurred at significantly lower levels of myocardial oxygen demand than after exercise. This suggests that an impairment of coronary blood supply is responsible. Thus, in smokers with coronary artery disease, each cigarette can cause profound silent disturbances of regional myocardial perfusion that are likely to occur frequently during daily life. Such repeated insults may represent an important mechanism linking smoking with coronary events.
吸烟与缺血性心脏病和急性冠状动脉事件密切相关。我们使用正电子发射断层扫描和铷 - 82（82Rb）对13例患有典型稳定型心绞痛的慢性吸烟者进行了研究，以探讨吸一支烟对局部心肌灌注的影响。研究结果与体育锻炼的影响进行了比较。运动后，8例患者（61%）出现心绞痛、ST段压低和局部心肌灌注异常。在远离缺血区的心肌中，82Rb摄取量从49±8增加到60±7，但在缺血区从46±3减少到37±5。其余5例患者（39%）82Rb摄取量均匀增加，未出现心绞痛或ST段压低。吸烟后，运动试验反应阳性的8例患者中有6例82Rb摄取量下降，在运动时受影响的同一心肌节段中，从47±3降至35±6。然而，与运动不同的是，吸烟过程中的事件大多是无症状的。吸烟后局部82Rb摄取量的绝对下降发生在心肌需氧量明显低于运动后的水平。这表明冠状动脉供血受损是原因所在。因此，在患有冠状动脉疾病的吸烟者中，每支香烟都可能导致局部心肌灌注出现严重的无症状性紊乱，且这种情况在日常生活中可能经常发生。这种反复的损伤可能是吸烟与冠状动脉事件之间联系的一个重要机制。
