Goldberg S, Lam W, Mudge G, Green L H, Kushner F, Hirshfeld J W, Kastor J A
Am J Cardiol. 1979 Mar;43(3):481-7. doi: 10.1016/0002-9149(79)90003-1.
Arterial pressure, coronary sinus blood flow with the thermodilution technique and calculated coronary vascular resistance were measured and coronary arteriography performed at rest and after the administration of ergonovine in 14 patients with atypical chest pain (group 1) and 6 patients with variant angina (group II). Mild diffuse narrowing of the left coronary bed in group I was not accompanied by S-T segment shifts, and coronary vascular resistance did not change significantly. In contrast, severe focal spasm (greater than 90 percent narrowing) of the left anterior descending coronary artery in group II patients was accompanied by S-T elevation and a marked overall increase in coronary vascular resistance (from 0.65 +/- 0.07 to 1.14 +/- 0.10 mm Hg/ml per min) (P less than 0.005). In addition, the myocardial arteriovenous oxygen difference increased and net lactate extraction changed to lactate production in the two patients in group II in whom these measurements were made. Thus, thermodilution coronary sinus blood flow measurement may be a sensitive method for detecting primary increases in coronary vascular resistance due to a high grade focal spasm in the left anterior descending coronary artery.
对14例非典型胸痛患者（第1组）和6例变异型心绞痛患者（第II组）在静息时以及给予麦角新碱后测量动脉压、采用热稀释技术测量冠状窦血流量并计算冠状血管阻力，同时进行冠状动脉造影。第1组患者左冠状动脉床轻度弥漫性狭窄，但未伴有ST段移位，冠状血管阻力也无显著变化。相比之下，第II组患者左前降支冠状动脉严重局限性痉挛（狭窄大于90%）伴有ST段抬高以及冠状血管阻力显著总体增加（从0.65±0.07增至1.14±0.10 mmHg/ml每分钟）（P<0.005）。此外，在第II组中进行了这些测量的两名患者，心肌动静脉氧差增加，净乳酸摄取转变为乳酸生成。因此，热稀释法测量冠状窦血流量可能是检测由于左前降支冠状动脉高度局限性痉挛导致冠状血管阻力原发性增加的一种敏感方法。
