冠状动脉成形术后冠状动脉阻力血管功能的延迟恢复。

Delayed recovery of coronary resistive vessel function after coronary angioplasty.

作者信息

Uren N G, Crake T, Lefroy D C, de Silva R, Davies G J, Maseri A

机构信息

Department of Medicine, Hammersmith Hospital, London, England.

出版信息

J Am Coll Cardiol. 1993 Mar 1;21(3):612-21. doi: 10.1016/0735-1097(93)90092-f.

DOI:10.1016/0735-1097(93)90092-f

PMID:8436742

Abstract

OBJECTIVES

The aim of this study was to use Doppler catheterization and sequential dynamic positron emission tomography (PET) to investigate the role and time course of abnormal coronary resistive vessel function in the impairment of the coronary vasodilator response (maximal/basal coronary blood flow) after successful coronary angioplasty.

BACKGROUND

The coronary vasodilator response may be impaired immediately after coronary angioplasty, despite successful dilation of a flow-limiting stenosis.

METHODS

Twelve men (mean age 52 +/- 10 years) with single-vessel coronary artery disease and normal left ventricular function were studied. The coronary vasodilator response to intravenous dipyridamole (0.5 mg.kg-1 over 4 min) was determined from intracoronary Doppler measurement of coronary flow velocity, before and after successful angioplasty. Basal and maximal myocardial blood flow in the angioplasty region and a normal region were determined in nine patients wtih positron emission tomography with H2(15)0 at 1 day (PET1), 7 days (PET2) and 3 months (PET3) after angioplasty.

RESULTS

The coronary vasodilator response, measured by Doppler catheterization, was similar before and immediately after angioplasty, 1.63 +/- 0.41 and 1.62 +/- 0.55, respectively (p = NS). After angioplasty, in seven of nine patients without restenosis, basal myocardial blood flow at PET1, PET2 and PET3 was 0.98 +/- 0.16, 0.94 +/- 0.09 and 0.99 +/- 0.13 ml.min-1 x g-1, respectively, in the remote region and 1.19 +/- 0.23 (p < 0.01 vs. remote region), 1.17 +/- 0.19 (p < 0.01 vs. remote region) and 1.10 +/- 0.08 ml.min-1 x g-1 (p = NS vs. remote region), respectively, in the angioplasty region. Myocardial blood flow after dipyridamole at PET1, PET2 and PET3 was 3.04 +/- 0.68, 3.00 +/- 0.71 and 3.00 +/- 0.60 ml.min-1 x g-1, respectively, in the remote region and 2.11 +/- 0.80 (p < 0.01 vs. remote region), 2.28 +/- 0.73 (p = NS vs. remote region) and 3.06 +/- 0.86 ml.min-1 x g-1 (p = NS vs. remote region), respectively, in the angioplasty region. The coronary vasodilator response at PET1, PET2 and PET3 was 3.15 +/- 0.85, 3.18 +/- 0.68 and 3.08 +/- 0.75, respectively, in the remote region and 1.80 +/- 0.68 (p < 0.01 vs. remote region), 1.94 +/- 0.49 (p < 0.01 vs. remote region) and 2.77 +/- 0.74 (p = NS vs. remote region), respectively, in the angioplasty region.

CONCLUSIONS

After successful angioplasty, basal myocardial blood flow is increased for > or = 7 days in the angioplasty region, with a reduction in the dipyridamole-induced increase in maximal myocardial blood flow for > or = 24 h after the procedure. Thus, the coronary vasodilator response is impaired for > or = 7 days after angioplasty, indicating that there is abnormal resistive vessel function in the coronary vascular bed distal to a coronary artery stenosis that persists for 7 days to 3 months.

摘要

目的

本研究旨在使用多普勒导管插入术和序贯动态正电子发射断层扫描（PET）来研究异常冠状动脉阻力血管功能在冠状动脉血管成形术成功后对冠状动脉扩张反应（最大/基础冠状动脉血流量）损害中的作用及时间进程。

背景

尽管限流性狭窄成功扩张，但冠状动脉血管成形术后冠状动脉扩张反应可能立即受损。

方法

对12名单支冠状动脉疾病且左心室功能正常的男性（平均年龄52±10岁）进行研究。在血管成形术成功前后，通过冠状动脉内多普勒测量冠状动脉流速来确定对静脉注射双嘧达莫（4分钟内0.5mg·kg⁻¹）的冠状动脉扩张反应。在血管成形术后1天（PET1）、7天（PET2）和3个月（PET3），对9名患者使用H₂¹⁵O通过正电子发射断层扫描确定血管成形术区域和正常区域的基础和最大心肌血流量。

结果

通过多普勒导管插入术测量的冠状动脉扩张反应在血管成形术前和术后即刻相似，分别为1.63±0.41和1.62±0.55（p=无显著差异）。血管成形术后，在9名无再狭窄的患者中，7名患者的PET1、PET2和PET3时，在远离血管成形术区域的基础心肌血流量分别为0.98±0.16、0.94±0.09和0.99±0.13ml·min⁻¹×g⁻¹，在血管成形术区域分别为1.19±0.23（与远离血管成形术区域相比p<0.01）、1.17±0.19（与远离血管成形术区域相比p<0.01）和1.10±0.08ml·min⁻¹×g⁻¹（与远离血管成形术区域相比p=无显著差异）。PET1、PET2和PET3时双嘧达莫后的心肌血流量在远离血管成形术区域分别为3.04±0.68、3.00±0.71和3.00±0.60ml·min⁻¹×g⁻¹，在血管成形术区域分别为2.11±0.80（与远离血管成形术区域相比p<0.01）、2.28±0.73（与远离血管成形术区域相比p=无显著差异）和3.06±0.86ml·min⁻¹×g⁻¹（与远离血管成形术区域相比p=无显著差异）。PET1、PET2和PET3时冠状动脉扩张反应在远离血管成形术区域分别为3.15±0.85、3.18±0.68和3.08±0.75，在血管成形术区域分别为1.80±0.68（与远离血管成形术区域相比p<0.01）、1.94±0.49（与远离血管成形术区域相比p<0.01）和2.77±0.74（与远离血管成形术区域相比p=无显著差异）。