Hongo M, Goto T, Watanabe N, Nakatsuka T, Tanaka M, Kinoshita O, Yamada H, Okubo S, Sekiguchi M
First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan.
Circulation. 1993 Sep;88(3):953-60. doi: 10.1161/01.cir.88.3.953.
Our objective was to assess phasic coronary blood flow and velocity characteristics of the proximal portion of the left anterior descending artery and to evaluate their relation to the clinical and hemodynamic manifestations in patients with aortic valve disease.
We examined 26 patients with chronic aortic regurgitation (AR), 12 patients with predominant aortic stenosis (AS), and 11 control subjects using an intravascular Doppler catheter with spectral analysis. Angiographic assessment of AR identified 10 patients with mild regurgitation and 16 with severe regurgitation. The resting systolic coronary flow velocity-time integral (VTI) was significantly higher and the diastolic VTI was slightly but significantly higher in patients with severe regurgitation than in those with mild regurgitation (11.8 +/- 4.2 vs 4.1 +/- 1.1 cm, P < .001; 18.5 +/- 5.8 vs 13.2 +/- 3.2 cm, P < .05) and control subjects (4.0 +/- 1.0 cm, P < .001 and 13.3 +/- 3.6 cm, P < .05), respectively. Patients with AS had a slightly lower resting systolic VTI (3.8 +/- 1.4 cm) and a higher diastolic VTI (14.6 +/- 3.7 cm) than control subjects. Resting coronary blood flow was greater in patients with aortic valve disease than in control subjects. There was a significant correlation between the ratio of the resting systolic to diastolic VTI (S/D ratio) and the ratio of the aortic systolic to diastolic pressure (r = .75, P < .001) in patients with AR. The S/D ratio was inversely correlated with left ventricular systolic pressure (r = -.92, P < .001) and positively correlated with the ratio of the aortic systolic to diastolic pressure (r = .68, P < .05) in patients with AS.
Our results indicate that hemodynamic changes related to aortic valve disease contribute to alterations in the resting phasic coronary blood flow and velocity profiles observed in these patients.
我们的目的是评估左前降支近端的阶段性冠状动脉血流和速度特征，并评估它们与主动脉瓣疾病患者临床及血流动力学表现的关系。
我们使用带有频谱分析的血管内多普勒导管检查了26例慢性主动脉瓣关闭不全（AR）患者、12例以主动脉瓣狭窄（AS）为主的患者和11例对照受试者。对AR患者进行血管造影评估，确定10例轻度反流患者和16例重度反流患者。重度反流患者静息收缩期冠状动脉血流速度时间积分（VTI）显著更高，舒张期VTI虽略高但也显著高于轻度反流患者（分别为11.8±4.2 vs 4.1±1.1 cm，P<.001；18.5±5.8 vs 13.2±3.2 cm，P<.05）及对照受试者（4.0±1.0 cm，P<.001和13.3±3.6 cm，P<.05）。AS患者静息收缩期VTI略低（3.8±1.4 cm），舒张期VTI高于对照受试者（14.6±3.7 cm）。主动脉瓣疾病患者的静息冠状动脉血流量大于对照受试者。AR患者静息收缩期与舒张期VTI之比（S/D比）与主动脉收缩压与舒张压之比显著相关（r=.75，P<.001）。AS患者的S/D比与左心室收缩压呈负相关（r=-.92，P<.001），与主动脉收缩压与舒张压之比呈正相关（r=.68，P<.05）。
我们的结果表明，与主动脉瓣疾病相关的血流动力学变化导致了这些患者静息阶段性冠状动脉血流和速度分布的改变。
