冠心病患者正常动脉所供血心肌的冠状动脉血管舒张储备及代谢改变。

Altered coronary vasodilator reserve and metabolism in myocardium subtended by normal arteries in patients with coronary artery disease.

作者信息

Uren N G, Marraccini P, Gistri R, de Silva R, Camici P G

机构信息

MRC Cyclotron Unit, Hammersmith Hospital, London, United Kingdom.

出版信息

J Am Coll Cardiol. 1993 Sep;22(3):650-8. doi: 10.1016/0735-1097(93)90172-w.

DOI:10.1016/0735-1097(93)90172-w

PMID:8354794

Abstract

OBJECTIVES

The aim of this study was to investigate coronary vasodilator reserve and metabolism in myocardium subtended by angiographically normal arteries remote from ischemia.

BACKGROUND

After infarction, structural and functional changes occur in remote myocardium often subtended by normal arteries. Whether changes occur in regions remote from ischemic but noninfarcted myocardium is unknown.

METHODS

Coronary vasodilator reserve was measured with positron emission tomography in 12 patients with single-vessel disease using intravenous dipyridamole (0.56 mg/kg for 4 min). In another 10 patients, simultaneous arterial/great cardiac vein catheterization was performed during atrial pacing to measure myocardial metabolism in regions subtended by diseased or normal arteries.

RESULTS

Basal myocardial blood flow in stenosis-related regions was comparable to that in remote regions but was lower after dipyridamole administration (1.73 +/- 0.91 vs. 2.89 +/- 0.93 ml/min per g, p < 0.01), giving coronary vasodilator reserve values of 1.80 +/- 0.82 and 2.73 +/- 0.89 (p < 0.01). In normal control subjects, basal myocardial blood flow was 0.92 +/- 0.13 and 3.67 +/- 0.94 ml/min per g in the basal state and after dipyridamole (both p < 0.05 vs. values in remote regions), and coronary vasodilator reserve was 4.07 +/- 0.98 (p < 0.01) vs. values in remote regions). During pacing there was net lactate release in diseased regions (-18 +/- 27%, p < 0.05 vs. values in remote regions and control subjects) and extraction in remote regions (38 +/- 17%) and in normal control subjects (26 +/- 11%). Glucose and alanine extraction were increased in diseased (8 +/- 6% and 6 +/- 6%) and remote regions (6 +/- 3% and 4 +/- 3%), compared with values in normal control subjects (2 +/- 3% and -1 +/- 3%, both p < 0.05 vs. diseased and remote regions).

CONCLUSIONS

Coronary vasodilator reserve is reduced and glucose and alanine metabolism is abnormal in regions subtended by normal arteries remote from ischemic but noninfarcted myocardium.

摘要

目的

本研究旨在调查远离缺血区域的造影正常动脉所供血心肌的冠状动脉扩张储备和代谢情况。

背景

心肌梗死后，远离梗死灶的心肌常由正常动脉供血，其结构和功能会发生改变。而远离缺血但未梗死心肌区域是否发生变化尚不清楚。

方法

对12名单支血管病变患者采用静脉注射双嘧达莫（0.56mg/kg，持续4分钟），用正电子发射断层扫描测量冠状动脉扩张储备。另外10名患者在心房起搏时同时进行动脉/大心静脉插管，以测量病变或正常动脉所供血区域的心肌代谢。

结果

狭窄相关区域的基础心肌血流量与远离区域相当，但在注射双嘧达莫后较低（分别为1.73±0.91和2.89±0.93ml/min per g，p<0.01），冠状动脉扩张储备值分别为1.80±0.82和2.73±0.89（p<0.01）。在正常对照受试者中，基础状态和注射双嘧达莫后的基础心肌血流量分别为0.92±0.13和3.67±0.94ml/min per g（与远离区域的值相比，p均<0.05），冠状动脉扩张储备为4.07±0.98（与远离区域的值相比，p<0.01）。起搏期间，病变区域有净乳酸释放（-18±27%，与远离区域和对照受试者的值相比，p<0.05），远离区域和正常对照受试者有乳酸摄取（分别为38±17%和26±11%）。与正常对照受试者相比（分别为2±3%和-1±3%，与病变和远离区域相比，p均<0.05），病变区域和远离区域的葡萄糖和丙氨酸摄取增加（分别为8±6%和6±6%以及6±3%和4±3%）。