Stone D A, Corretti M C, Hawke M W, Herzog W, Rodriguez S, Plotnick G D
Department of Medicine, University of Maryland Hospital, Baltimore 21201-1595, USA.
Clin Cardiol. 1995 Apr;18(4):205-8. doi: 10.1002/clc.4960180405.
Previous studies using thallium-201 scintigraphy have suggested that angiographic coronary collaterals can protect against the development of stress-induced perfusion abnormalities, but the effect of collaterals on stress echocardiography (SECHO) has not been determined. In this study, 21 consecutive patients referred for cardiac catheterization underwent SECHO and coronary angiography. Of the 21 study patients, there was a total of 16 significantly obstructed coronary arteries (> or = 70% stenosis) in 14 patients. SECHO revealed stress-induced wall motion abnormalities in the distribution of seven of nine obstructed coronary vessels without angiographic collaterals, but in only one of seven vessels with collaterals (p < 0.05). Six of eight obstructed vessels not associated with a stress-induced wall motion abnormality had collaterals, whereas only one of eight obstructed vessels associated with a stress-induced wall motion abnormality had collaterals. We conclude that (1) angiographically demonstrated coronary collaterals can protect against the development of stress-induced wall motion abnormalities despite the presence of a high-grade coronary artery obstruction, and (2) the lack of a stress-induced wall motion abnormality on SECHO in the perfusion territory of an obstructed vessel may suggest the presence of adequate collateral perfusion.
以往使用铊-201闪烁扫描法的研究表明，血管造影显示的冠状动脉侧支循环可预防应激诱发的灌注异常的发生，但侧支循环对应激超声心动图（SECHO）的影响尚未确定。在本研究中，21例连续接受心脏导管插入术的患者接受了SECHO和冠状动脉造影检查。在这21例研究患者中，14例患者共有16支冠状动脉存在明显狭窄（狭窄程度≥70%）。SECHO显示，在9支无血管造影侧支循环的阻塞性冠状动脉中，有7支血管分布区域出现了应激诱发的壁运动异常，而在7支有侧支循环的血管中，只有1支出现了这种异常（p<0.05）。8支与应激诱发的壁运动异常无关的阻塞性血管中有6支有侧支循环，而8支与应激诱发的壁运动异常有关的阻塞性血管中只有1支有侧支循环。我们得出结论：（1）尽管存在严重的冠状动脉阻塞，但血管造影显示的冠状动脉侧支循环可预防应激诱发的壁运动异常的发生；（2）在阻塞性血管的灌注区域，SECHO未出现应激诱发的壁运动异常可能提示存在足够的侧支循环灌注。
