Smalling R W, Kelley K, Kirkeeide R L, Fisher D J
J Am Coll Cardiol. 1985 Apr;5(4):948-55. doi: 10.1016/s0735-1097(85)80438-1.
It has been suggested that vasodilation distal to a stenosis may cause a profound decrease in perfusion pressure and adversely affect regional left ventricular function. This phenomenon could explain the clinical concept of reversal of regional dysfunction by coronary revascularization. To evaluate the hypothesis that regional myocardial function parallels regional coronary blood pressure in the absence of changes in coronary flow, dogs chronically instrumented with left circumflex coronary artery flow probes, cuff occluders, pressure catheters and segmental function sonomicrometers were studied. By decreasing regional coronary vascular resistance with selective intracoronary dipyridamole and controlling blood flow with a proximal coronary cuff occluder, the mean left circumflex artery pressure was reduced from 83 +/- 3 to 38 +/- 2 mm Hg while circumflex coronary blood flow was maintained constant. Regional contractile function as measured by circumflex sonomicrometers was unchanged at constant circumflex subendocardial blood flow as measured by radioactive microspheres. These findings suggest that regional contractile function is dependent on subendocardial blood flow and is independent of coronary perfusion pressure.
有人提出，狭窄远端的血管舒张可能导致灌注压显著降低，并对局部左心室功能产生不利影响。这一现象可以解释通过冠状动脉血运重建逆转局部功能障碍的临床概念。为了评估在冠状动脉血流无变化的情况下局部心肌功能与局部冠状动脉血压平行的假说，对长期植入左旋冠状动脉血流探头、袖带封堵器、压力导管和节段性功能超声微测计的犬进行了研究。通过选择性冠状动脉内注射双嘧达莫降低局部冠状动脉血管阻力，并使用近端冠状动脉袖带封堵器控制血流，左旋冠状动脉平均压力从83±3mmHg降至38±2mmHg，而左旋冠状动脉血流保持恒定。通过放射性微球测量，在左旋心内膜下血流恒定的情况下，用左旋超声微测计测量的局部收缩功能没有变化。这些发现表明，局部收缩功能取决于心内膜下血流，而与冠状动脉灌注压无关。
