Brown B G, Bolson E, Petersen R B, Pierce C D, Dodge H T
Circulation. 1981 Dec;64(6):1089-97. doi: 10.1161/01.cir.64.6.1089.
The effect of sublingual or intracoronary nitroglycerin (NTG) on luminal caliber in normal and diseased portions of epicardial coronary arteries was determined in 85 lesions from 57 typical patients with ischemic heart disease. Measurements were made from coronary angiograms, using a computer-assisted method and a carefully blinded protocol for analysis of the pre- and post- NTG angiograms. Luminal area in the "normal" portion of the diseased segment and at its maximum constriction and an estimate of flow resistance in the stenosis were computed. Luminal area increased 1.27 mm2 (p less than 0.001) in the "normal" regions, an average increase of 18% over the control area. Dilation with NTG depended strongly on vessel size; area increased 35% in normal vessels of 1.6-2.3 mm luminal diameter and only 9% in vessels 4.0-5.0 mm in diameter. Lesions were grouped into four levels of severity by percent stenosis. Minimum luminal area increased 0.35 mm2 (p less than 0.01) at the narrowest point in moderate lesions, a 22% area increase, and 0.14 mm2 (p less than 0.001) in severe lesions, a 36% area increase. Stenosis dilation resulted in an average 25% reduction (p less than 0.01) in estimated stenosis flow resistance in moderate lesions and a 38% reduction (p less than 0.001) in severe lesions. A statistically significant resistance reduction of greater than 20% occurred in 15 to 20 severe stenoses; only two of 20 showed no measurable dilation. We reviewed recent literature on hemodynamic responses to NTG and determined that changes of this magnitude are among the largest reported. We conclude that vasodilation of epicardial coronary stenosis is usually a major component of the beneficial response to NTG. We support that conclusion by demonstrating a striking improvement in ischemic left ventricular compliance abnormalities after low-dose intracoronary NTG.
在57例典型缺血性心脏病患者的85处病变中，测定了舌下含服或冠状动脉内注射硝酸甘油（NTG）对心外膜冠状动脉正常段和病变段管腔内径的影响。采用计算机辅助方法和严格的双盲方案对NTG注射前后的冠状动脉造影进行分析测量。计算病变节段“正常”部分及其最大狭窄处的管腔面积，并估算狭窄处的血流阻力。“正常”区域的管腔面积增加了1.27平方毫米（p<0.001），比对照面积平均增加了18%。NTG引起的扩张强烈依赖于血管大小；管腔直径为1.6 - 2.3毫米的正常血管面积增加35%，而直径为4.0 - 5.0毫米的血管仅增加9%。根据狭窄百分比将病变分为四个严重程度级别。中度病变最窄处的最小管腔面积增加了0.35平方毫米（p<0.01），面积增加22%；重度病变增加了0.14平方毫米（p<0.001），面积增加36%。狭窄扩张使中度病变的估计狭窄血流阻力平均降低25%（p<0.01），重度病变降低38%（p<0.001）。在15至20处严重狭窄中，有统计学意义的阻力降低大于20%；20处中只有两处未显示出可测量的扩张。我们回顾了近期关于NTG血流动力学反应的文献，确定这种程度的变化是报道中最大的之一。我们得出结论，心外膜冠状动脉狭窄的血管扩张通常是对NTG有益反应的主要组成部分。通过证明低剂量冠状动脉内注射NTG后缺血性左心室顺应性异常有显著改善，我们支持这一结论。
