单支冠状动脉疾病患者对氧耗增加的灌注反应的整体改变。

Global alteration in perfusion response to increasing oxygen consumption in patients with single-vessel coronary artery disease.

作者信息

Sambuceti G, Marzullo P, Giorgetti A, Neglia D, Marzilli M, Salvadori P, L'Abbate A, Parodi O

机构信息

CNR Institute of Clinical Physiology, Pisa, Italy.

出版信息

Circulation. 1994 Oct;90(4):1696-705. doi: 10.1161/01.cir.90.4.1696.

DOI:10.1161/01.cir.90.4.1696

PMID:7923653

Abstract

BACKGROUND

Recent evidence suggests that, in coronary artery disease (CAD), myocardial blood flow (MBF) regulation is abnormal in regions supplied by apparently normal coronary arteries. However, the relation between this alteration and MBF response to increasing metabolic demand has not been fully elucidated.

METHODS AND RESULTS

MBF was assessed at baseline, during atrial pacing tachycardia, and after dipyridamole (0.56 mg/kg IV over 4 minutes) in 9 normal subjects and in 24 patients with ischemia on effort, no myocardial infarction, and isolated left anterior descending (n = 19) or left circumflex (n = 5) coronary artery stenosis (> or = 50% diameter narrowing). Perfusion of both poststenotic (S) and normally supplied (N) areas was measured off therapy by positron emission tomography and [13N]ammonia. Normal subjects and CAD patients showed similar rate-pressure products at baseline, during pacing, and after dipyridamole. In CAD patients, MBF was lower in S than in N territories at rest (0.68 +/- 0.14 versus 0.74 +/- 0.18 mL.min-1.g-1, respectively, P < .05), during pacing (0.92 +/- 0.29 versus 1.16 +/- 0.40 mL.min-1.g-1, respectively, P < .01), and after dipyridamole (1.18 +/- 0.34 versus 1.77 +/- 0.71 mL.min-1.g-1, respectively, P < .01). However, normal subjects showed significantly higher values of MBF both at rest (0.92 +/- 0.13 mL.min-1.g-1, P < .05 versus both S and N areas), during pacing tachycardia (1.95 +/- 0.64 mL.min-1.g-1, P < .01 versus both S and N areas), and after dipyridamole (3.59 +/- 0.71 mL.min-1.g-1, P < .01 versus both S and N areas). The percent change in flow was strictly correlated with the corresponding change in rate-pressure product in normal subjects (r = .85, P < .01) but not in either S (r = .04, P = NS) or N regions (r = .08, P = NS) of CAD patients.

CONCLUSIONS

Besides epicardial stenosis, further factors may affect flow response to increasing metabolic demand and coronary reserve in patients with CAD.

摘要

背景

最近的证据表明，在冠状动脉疾病（CAD）中，明显正常的冠状动脉所供血区域的心肌血流（MBF）调节异常。然而，这种改变与MBF对代谢需求增加的反应之间的关系尚未完全阐明。

方法与结果

对9名正常受试者以及24例运动诱发缺血、无心肌梗死且孤立性左前降支（n = 19）或左旋支（n = 5）冠状动脉狭窄（直径狭窄≥50%）的患者，在基线、心房起搏性心动过速期间以及双嘧达莫（4分钟内静脉注射0.56 mg/kg）后评估MBF。通过正电子发射断层扫描和[13N]氨测量治疗前狭窄后（S）区域和正常供血（N）区域的灌注。正常受试者和CAD患者在基线、起搏期间以及双嘧达莫后显示出相似的心率 - 血压乘积。在CAD患者中，静息时S区域的MBF低于N区域（分别为0.68±0.14与0.74±0.18 mL·min-1·g-1，P <.05），起搏期间（分别为0.92±0.29与1.16±0.40 mL·min-1·g-1，P <.01），以及双嘧达莫后（分别为1.18±0.34与1.77±0.71 mL·min-1·g-1，P <.01）。然而，正常受试者在静息时（0.92±0.13 mL·min-1·g-1，与S和N区域相比P <.05）、起搏性心动过速期间（1.95±0.64 mL·min-1·g-1，与S和N区域相比P <.01）以及双嘧达莫后（3.59±0.71 mL·min-1·g-1，与S和N区域相比P <.01）的MBF值显著更高。正常受试者中血流的百分比变化与心率 - 血压乘积的相应变化密切相关（r =.85，P <.01），但CAD患者的S区域（r =.04，P =无显著性差异）或N区域（r =.08，P =无显著性差异）并非如此。