Bertrand M E, LaBlanche J M, Tilmant P Y, Thieuleux F P, Delforge M R, Carré A G
Am J Cardiol. 1981 Feb;47(2):199-205. doi: 10.1016/0002-9149(81)90384-2.
In 46 patients with aortic valve disease, coronary sinus blood flow was measured using a continuous thermodilution method both at rest and during isometric handgrip exercise. All patients had normal coronary angiograms. The patients were separated into three groups: Group I, 12 patients with aortic stenosis (systolic gradient 72 +/- 12 mm Hg); Group II, 15 patients with both aortic stenosis and regurgitation; Group III, 19 patients with aortic regurgitation. At rest, the coronary sinus blood flow was two to three times normal. However, when corrected for left ventricular mass (ml/100 g), flow was within normal limits. The ratio diastolic pressure-time index/systolic pressure-time index (DPTI/SPTI) was decreased in all three groups at rest. During isometric exercise, coronary sinus blood flow increased significantly: by 60 percent in Group I, by 88 percent in Group II and by 118 percent in Group III. There was a significant reduction of the DPTI/SPTI ratio. Of the 18 patients with angina on effort during the test, 7 were in Group I, 6 in Group II and 5 in Group III. There were no differences in the coronary sinus blood flow between the patients with angina and those who were pain-free, either at rest or during exercise. Angina pectoris does not appear to be caused by a failure of coronary blood flow to increase. There was no discrepancy between myocardial demand, as measured by the pressure-time index and coronary blood flow. However, the DPTI/SPTI ratio was significantly lower during exercise in the patients with angina than in those who were pain-free. Underperfusion of the subendocardial muscle seems to be a causative factor in the patients with angina.
对46例主动脉瓣疾病患者，采用连续热稀释法在静息状态和等长握力运动期间测量冠状窦血流量。所有患者冠状动脉造影均正常。患者被分为三组：第一组，12例主动脉狭窄患者（收缩期压差72±12 mmHg）；第二组，15例主动脉狭窄合并关闭不全患者；第三组，19例主动脉关闭不全患者。静息时，冠状窦血流量是正常的两到三倍。然而，以左心室质量校正后（ml/100 g），血流量在正常范围内。所有三组患者静息时舒张压-时间指数/收缩压-时间指数（DPTI/SPTI）均降低。等长运动期间，冠状窦血流量显著增加：第一组增加60%，第二组增加88%，第三组增加118%。DPTI/SPTI比值显著降低。在测试期间进行运动时发生心绞痛的18例患者中，第一组7例，第二组6例，第三组5例。心绞痛患者与无痛患者在静息或运动时冠状窦血流量无差异。心绞痛似乎并非由冠状动脉血流量未能增加所致。通过压力-时间指数测量的心肌需求与冠状动脉血流量之间没有差异。然而，运动期间心绞痛患者的DPTI/SPTI比值显著低于无痛患者。心内膜下心肌灌注不足似乎是心绞痛患者的一个致病因素。
