冠状动脉正常且有非典型胸痛的患者对麦角新碱反应的冠状动脉血流动力学变异性。

Variability in coronary hemodynamics in response to ergonovine in patients with normal coronary arteries and atypical chest pain.

作者信息

Schwartz A B, Donmichael T A, Botvinick E H, Ishimori T, Parmley W W, Chatterjee K

出版信息

J Am Coll Cardiol. 1983 Mar;1(3):797-803. doi: 10.1016/s0735-1097(83)80193-4.

Abstract

Because an increase in coronary vascular resistance in response to ergonovine maleate has been suggested as a possible diagnostic aid for variant angina, changes were evaluated in coronary hemodynamics and serial myocardial thallium-201 perfusion scans in 15 patients without angina and with normal coronary arteries in response to ergonovine (0.05, 0.10 and 0.20 mg intravenously). For the group, heart rate-blood pressure product increased significantly (p less than 0.001) without any change in coronary sinus flow, coronary vascular resistance, myocardial oxygen extraction, arterial-coronary sinus oxygen difference and lactate extraction. In 7 of 15 patients, however, coronary vascular resistance increased (mean 39%, range 11 to 75%, probability [p] less than 0.001), and coronary sinus flow decreased (14%, p less than 0.001), despite an increase in heart rate-blood pressure product (36%, p less than 0.02). No electrocardiographic, metabolic or thallium-201 scan abnormalities occurred. Therefore, significant increases in coronary vascular resistance in response to ergonovine may occur in patients with normal coronary arteries and atypical chest pain.

摘要

由于有人提出，对马来酸麦角新碱的反应性冠状动脉血管阻力增加可能有助于变异型心绞痛的诊断，因此我们对15例无心绞痛且冠状动脉正常的患者静脉注射麦角新碱（0.05、0.10和0.20毫克）后，评估了其冠状动脉血流动力学变化及系列心肌铊-201灌注扫描结果。对于该组患者，心率-血压乘积显著增加（p<0.001），而冠状窦血流量、冠状动脉血管阻力、心肌氧摄取、动脉-冠状窦氧分压差及乳酸摄取均无变化。然而，在15例患者中的7例，尽管心率-血压乘积增加（36%，p<0.02），冠状动脉血管阻力仍增加（平均39%，范围11%至75%，概率[p]<0.001），冠状窦血流量减少（14%，p<0.001）。未出现心电图、代谢或铊-201扫描异常。因此，冠状动脉正常且有非典型胸痛的患者对麦角新碱的反应性冠状动脉血管阻力可能会显著增加。