冠状动脉顺应性降低对左心室的收缩作用是冠心病患者舒张功能降低的一个重要原因。

The constricting effect of reduced coronary artery compliance on the left ventricle is an important cause of reduced diastolic function in patients with coronary heart disease.

机构信息

The Third Affiliated Hospital, Southern Medical University or The Third School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China.

Shanghai Maritime University, Shanghai, China.

出版信息

BMC Cardiovasc Disord. 2022 Aug 17;22(1):375. doi: 10.1186/s12872-022-02809-0.

DOI:10.1186/s12872-022-02809-0

PMID:35978296

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9382726/

Abstract

BACKGROUND

Previous studies of left ventricular diastolic function (LVDF) have focused on the decrease in active and passive diastolic function due to ischemic factors but have not investigated if the decrease in compliance of the coronary arteries that bypass the surface of the heart and travel between the myocardium could cause a constricting effect on the ventricular wall like that caused by myocardial fibrosis.

METHODS AND RESULTS

581 patients diagnosed with coronary heart disease (CHD) were divided into A group (patients are the control group), B group (patients with less than 50% coronary artery stenosis), C group (patients with coronary artery stenosis between 50 and 75%), D group (patients with coronary artery stenosis greater than 75%) according to the degree of coronary stenosis. The diastolic function of the ventricle is reflected by applying the relaxation time constant T value, which refers to the time between peak dp/dt and end-diastolic pressure in the left ventricle. It was concluded that there was a statistical difference in Gensini scores between patients in groups B, C and D (P < 0.001). And multiple linear regression analysis showed that T was correlated with Gensini score and C-dp/dtmax (R = 0.711, P < 0.001). Grouping according to the site of stent implantation and the number of stents implanted, it was found out that the changes in T values before and after left anterior descending artery (LAD) stent implantation were greater than left circumflex artery (LCX) and right coronary artery (RCA) (P < 0.001). And multiple linear regression revealed a correlation between T values and stent length, ventricular stiffness, and C-dp/dtmax (P = 0.001).

CONCLUSIONS

The decrease in compliance of the coronary arteries bypassing the surface of the heart and travelling between the myocardium would cause a constricting effect on the ventricular wall like that caused by myocardial fibrosis.

摘要

背景

先前关于左心室舒张功能（LVDF）的研究主要集中在由于缺血因素导致的主动和被动舒张功能下降，但尚未研究绕过心脏表面并在心外膜之间穿行的冠状动脉顺应性下降是否会像心肌纤维化那样对心室壁产生收缩作用。

方法和结果

根据冠状动脉狭窄程度，将 581 例确诊为冠心病（CHD）的患者分为 A 组（对照组）、B 组（冠状动脉狭窄小于 50%）、C 组（冠状动脉狭窄 50%至 75%之间）、D 组（冠状动脉狭窄大于 75%）。心室舒张功能通过应用松弛时间常数 T 值来反映，T 值指左心室峰值 dp/dt 与舒张末期压之间的时间。研究发现，B、C 和 D 组患者的 Gensini 评分存在统计学差异（P<0.001）。多元线性回归分析显示 T 值与 Gensini 评分和 C-dp/dtmax 呈正相关（R=0.711，P<0.001）。根据支架植入部位和支架植入数量进行分组，发现左前降支（LAD）支架植入前后 T 值的变化大于左回旋支（LCX）和右冠状动脉（RCA）（P<0.001）。多元线性回归显示 T 值与支架长度、心室僵硬度和 C-dp/dtmax 呈正相关（P=0.001）。