Domalik-Wawrzynski L J, Powell W J, Guerrero L, Palacios I
Cardiac Unit, Massachusetts General Hospital, Boston 02114.
Circ Res. 1987 Nov;61(5):747-56. doi: 10.1161/01.res.61.5.747.
Since the gradient between aortic pressure and left ventricular diastolic pressure is a major determinant of coronary blood flow, a change in left ventricular relaxation by its effect on early diastole could diminish early diastolic coronary flow. Two interventions that resulted in impaired left ventricular relaxation, hypothermia, and reperfusion following a left anterior descending coronary artery occlusion were studied to evaluate whether there were associated changes in coronary blood flow. With both interventions, there was a significant prolongation of left ventricular relaxation (p less than 0.01) accompanied by a significant decrease in early diastolic coronary blood flow (p less than 0.01). Verapamil did not have a significant effect on these hemodynamic changes during hypothermia. However, verapamil significantly blunted the effects of reperfusion following ischemia on ventricular relaxation (p less than 0.002) and early diastolic coronary blood flow (p less than 0.01). Thus, impaired left ventricular relaxation has an adverse impact on early diastolic coronary blood flow, which, under the condition of reperfusion following regional myocardial ischemia, can be alleviated with calcium channel blockade.
由于主动脉压与左心室舒张压之间的压差是冠状动脉血流的主要决定因素，左心室舒张功能的改变通过影响舒张早期，可能会减少舒张早期的冠状动脉血流。本研究探讨了两种导致左心室舒张功能受损的干预措施，即低温和左前降支冠状动脉闭塞后的再灌注，以评估冠状动脉血流是否存在相关变化。在这两种干预措施下，左心室舒张时间均显著延长（p<0.01），同时舒张早期冠状动脉血流显著减少（p<0.01）。在低温期间，维拉帕米对这些血流动力学变化无显著影响。然而，维拉帕米显著减弱了缺血后再灌注对心室舒张（p<0.002）和舒张早期冠状动脉血流（p<0.01）的影响。因此，左心室舒张功能受损对舒张早期冠状动脉血流有不利影响，在局部心肌缺血后再灌注的情况下，钙通道阻滞剂可减轻这种影响。
