Eichstädt H W, Eskötter H, Hoffman I, Amthauer H W, Weidinger G
Department of Cardiology, Rudolf Virchow University Hospital, Free University of Berlin, Germany.
Am J Cardiol. 1995 Jul 13;76(2):122A-125A. doi: 10.1016/s0002-9149(05)80033-5.
Patients with hypercholesterolemia have impaired coronary and peripheral endothelial function. In patients with coronary artery disease, intracoronary acetylcholine infusion or mental stress causes paradoxical vasoconstriction, whereas lowering cholesterol restores endothelial function. The impact of lipid lowering by fluvastatin on myocardial perfusion in hypercholesterolemic patients with perfusion abnormalities was assessed by thallium-201 single photon-emission computed tomography (SPECT). A total of 22 patients were treated with fluvastatin (40 mg once daily) for 6 weeks, followed by 40 mg twice daily if low density lipoprotein cholesterol (LDL-C) levels were decreased by < or = 30%. During the 12-week treatment period, myocardial perfusion was measured by quantitative SPECT after standardized stress testing at baseline and after 12 weeks. Preliminary results for 17 male patients (mean age, 59.3 +/- 6.7 years) are presented here. LDL-C decreased from 191 +/- 26 to 146 +/- 28 mg/dL (p < 0.001). In ischemic segments myocardial perfusion increased by 30% (280 +/- 100 to 365 +/- 110 counts per matrix; p < 0.001). In normal segments perfusion increased by only 5% (451 +/- 74 to 473 +/- 69 counts per matrix; p < 0.005). The change in perfusion rate between ischemic and normal segments was significant (p < 0.005). In conclusion, LDL-C lowering with short-term fluvastatin therapy improved myocardial perfusion, especially in areas of ischemia. This suggests that improvement is due to functional restoration of coronary endothelium by fluvastatin, before anatomic regression of stenosis can occur following long-term treatment.
高胆固醇血症患者存在冠状动脉和外周血管内皮功能受损。在冠状动脉疾病患者中，冠状动脉内注入乙酰胆碱或精神应激会导致反常的血管收缩，而降低胆固醇水平可恢复内皮功能。通过铊-201单光子发射计算机断层扫描（SPECT）评估氟伐他汀降低血脂对存在灌注异常的高胆固醇血症患者心肌灌注的影响。共有22例患者接受氟伐他汀治疗（每日40毫克，一次），为期6周；如果低密度脂蛋白胆固醇（LDL-C）水平降低幅度小于或等于30%，则随后改为每日两次，每次40毫克。在为期12周的治疗期间，于基线和12周后进行标准化应激试验后，通过定量SPECT测量心肌灌注。本文给出了17例男性患者（平均年龄59.3±6.7岁）的初步结果。LDL-C从191±26降至146±28毫克/分升（p<0.001）。在缺血节段，心肌灌注增加了30%（从每矩阵280±100计数增至365±110计数；p<0.001）。在正常节段，灌注仅增加了5%（从每矩阵451±74计数增至473±69计数；p<0.005）。缺血节段和正常节段之间的灌注率变化具有显著性（p<0.005）。总之，短期氟伐他汀治疗降低LDL-C可改善心肌灌注，尤其是在缺血区域。这表明这种改善是由于氟伐他汀使冠状动脉内皮功能恢复，而在长期治疗使狭窄发生解剖学消退之前。
