Berglund H, Luo H, Nishioka T, Eigler N L, Kim C J, Tabak S W, Siegel R J
Department of Cardiology, Huddinge (Sweden) Hospital (Karolinska Institute).
Circulation. 1996 Dec 1;94(11):2871-6. doi: 10.1161/01.cir.94.11.2871.
Uncertainty exists regarding the effects of nitroglycerin on atherosclerotic segments of coronary arteries, and information on vasoreactivity of saphenous vein bypass grafts is sparse. Intravascular ultrasound enables identification of atherosclerosis in angiographically normal segments and allows continuous determination of alterations in cross-sectional lumen areas.
Patients with documented coronary atherosclerosis were studied. Vessel morphology and lumen area at baseline and after 100 to 200 micrograms nitroglycerin were assessed at 10-second intervals for 60 seconds in vessel segments without angiographically apparent lesions. Coronary artery saphenous vein bypass grafts from 11 patients were compared with native coronary arteries in 16 different patients. Atherosclerosis was present in all vessel segments studied. There was a rapid increase in lumen area compared with baseline after intravascular nitroglycerin in both native coronary arteries and saphenous vein bypass grafts. Maximum lumen area dilatation was 19.6 +/- 12.2% in saphenous vein bypass grafts and 19.7 +/- 13.1% in native coronary arteries. An earlier peak response in saphenous vein bypass grafts (34.5 +/- 6.9 seconds) compared with native coronary arteries (44.7 +/- 8.5 seconds; P = .003) was found. Vessel wall area remained constant during vasodilation, but there was a significant reduction in measured wall thickness (P = .034).
In patients with documented coronary artery disease, intravascular ultrasound reveals substantial atherosclerosis in angiographically normal vessel segments. In these vessel segments, both native coronary arteries and saphenous vein bypass grafts exhibit prompt vasodilation with the intravascular administration of nitroglycerin. The vasodilatory capacity in response to nitroglycerin seems to be preserved in transposed, denervated, and devascularized saphenous veins.
硝酸甘油对冠状动脉粥样硬化节段的影响尚不确定，且关于大隐静脉旁路移植血管血管反应性的信息较少。血管内超声能够识别血管造影正常节段中的动脉粥样硬化，并可连续测定横截面管腔面积的变化。
对有冠状动脉粥样硬化记录的患者进行研究。在血管造影无明显病变的血管节段，每隔10秒评估一次基线时以及给予100至200微克硝酸甘油后60秒内的血管形态和管腔面积。将11例患者的冠状动脉大隐静脉旁路移植血管与16例不同患者的自身冠状动脉进行比较。所有研究的血管节段均存在动脉粥样硬化。在自身冠状动脉和大隐静脉旁路移植血管中，血管内给予硝酸甘油后，管腔面积与基线相比迅速增加。大隐静脉旁路移植血管的最大管腔面积扩张为19.6±12.2%，自身冠状动脉为19.7±13.1%。发现大隐静脉旁路移植血管的峰值反应（34.5±6.9秒）早于自身冠状动脉（44.7±8.5秒；P = .003）。血管扩张期间血管壁面积保持不变，但测量的管壁厚度显著减小（P = .034）。
在有冠状动脉疾病记录的患者中，血管内超声显示血管造影正常的血管节段存在大量动脉粥样硬化。在这些血管节段，自身冠状动脉和大隐静脉旁路移植血管在血管内给予硝酸甘油后均表现出迅速的血管扩张。对硝酸甘油的血管舒张能力似乎在转位、去神经和无血管的大隐静脉中得以保留。
