心绞痛与正常心外膜冠状动脉：长期随访的放射性核素特征及病理生理意义

Angina and normal epicardial coronary arteries: radionuclide features and pathophysiological implications at long-term follow-up.

作者信息

Ciavolella M, Avella A, Bellagamba S, Mangieri E, Nigri A, Reale A

机构信息

II Department of Cardiology, La Sapienza University of Rome, Italy.

出版信息

Coron Artery Dis. 1994 Jun;5(6):493-9.

PMID:7952408

Abstract

BACKGROUND

The aim of this study was to identify specific characteristics associated with modifications of symptoms and to evaluate the presence of a pathophysiological link between radionuclide abnormalities and delayed run-off of coronary contrast dye in patients with angina and normal coronary arteries.

METHODS

We followed up 53 patients (21 men and 32 women, mean age: 52 +/- 10 years) with angina and angiographically normal epicardial coronary arteries, 21 of whom (40%) displayed a pattern of slow contrast dye run-off from coronary vessels, on visual assessment using a semiquantitative empirical score. Exercise tests showed ECG abnormalities in 29 patients (55%).

RESULTS

All patients were alive 92 +/- 44 months after catheterization (140 +/- 79 months after beginning of symptoms). However, 30 patients (57%), who reported worsening or no change of symptoms, presented with a non-significant higher prevalence of conduction abnormalities at rest ECG (27 versus 17%), pathological exercise tests (57 versus 52%), and delayed run-off (47 versus 30%). Regional left ventricular function and perfusion were then simultaneously assessed at rest and peak exercise with 99mTc-sestamibi. Exercise-induced radionuclide abnormalities were detected in 27 patients (51%), who also presented with a non-significant higher prevalence of pathological exercise tests (63 versus 43%) and no improvement of symptoms (63 versus 46%). However, exercise-induced functional and perfusional abnormalities were simultaneously present in 29 out of 42 (69%) coronary territories supplied by vessels with delayed run-off, versus 21 out of 117 (17%) normal territories (P = 0.00032).

CONCLUSIONS

Despite a good prognosis, some patients with angina and normal coronary arteries presented no improvement of symptoms at follow-up, and had functional and perfusional abnormalities in coronary territories supplied by vessels showing delayed contrast dye run-off.

摘要

背景

本研究的目的是确定与症状改变相关的特定特征，并评估心绞痛且冠状动脉正常的患者中放射性核素异常与冠状动脉造影剂延迟排空之间病理生理联系的存在情况。

方法

我们对53例心绞痛且心外膜冠状动脉造影正常的患者（21例男性和32例女性，平均年龄：52±10岁）进行了随访，其中21例（40%）在使用半定量经验评分进行视觉评估时显示出冠状动脉造影剂从冠状动脉缓慢排空的模式。运动试验显示29例患者（55%）存在心电图异常。

结果

所有患者在导管插入术后92±44个月（症状出现后140±79个月）均存活。然而，30例（57%）报告症状恶化或无变化的患者，静息心电图传导异常的患病率略高（27%对17%）、运动试验异常（57%对52%）以及延迟排空（47%对30%）。然后使用99mTc - 甲氧基异丁基异腈在静息和运动高峰时同时评估局部左心室功能和灌注。27例患者（51%）检测到运动诱发的放射性核素异常，这些患者运动试验异常的患病率也略高（63%对43%）且症状无改善（63%对46%）。然而，在造影剂延迟排空血管供应的42个冠状动脉节段中的29个（69%）同时存在运动诱发的功能和灌注异常，而在正常节段的117个中有21个（17%）出现这种情况（P = 0.00032）。