Claeys M J, Vrints C J, Bosmans J, Krug B, Blockx P P, Snoeck J P
Department of Cardiology, University Hospital Antwerp, Edegem, Belgium.
J Am Coll Cardiol. 1996 Dec;28(7):1712-9. doi: 10.1016/S0735-1097(96)00386-5.
In the present study, we examined post-stenotic coronary flow before and after percutaneous transluminal coronary angioplasty (PTCA) in patients with and without a recent myocardial infarction (MI) and related it to stenosis severity and residual viability.
Post-stenotic coronary blood flow velocity reserve (CFVR) has been used with success to estimate functional stenosis severity in patients with stable angina. However, in patients with a recent MI, the impaired coronary vasodilator response of the reperfused myocardium may substantially alter the flow dynamics of the infarct-related artery.
Distal coronary flow velocities were recorded before and after PTCA in 36 patients at day 13 +/- 7 (mean +/- SD) after acute MI and in 38 patients without MI. The CFVR was assessed by the ratio of distal hyperemic to baseline average peak velocity, using a 0.014-in. Doppler guide wire. Stenosis severity was analyzed by quantitative coronary angiography, and infarct size was assessed scintigraphically.
For similar angiographic stenosis severity, pre- and post-PTCA values of CFVR were significantly lower in patients with than without MI: 1.22 +/- 0.26 versus 1.50 +/- 0.45 before PTCA (p < 0.05) and 1.72 +/- 0.43 versus 2.21 +/- 0.74 after PTCA, respectively (p < 0.01). Although CFVR increased significantly (p < 0.0001) after angiographically successful PTCA in both study groups, abnormal CFVR (< or = 2.0) was still observed in 80% of patients with MI and in 44% of those without MI (MI vs. no MI, p = 0.001). Patients with an extensive infarction (relative infarct size > or = 50%) and those with a small infarction (relative infarct size < 50%) had comparable levels of post-PTCA CFVR (1.6 +/- 0.3 vs. 1.8 +/- 0.5, p = NS). Among a variety of factors, angiographic stenosis severity was the most important determinant of CFVR in both study groups.
In patients with a recent MI, CFVR was significantly lower than in those without MI, both before and after PTCA. Besides the presence of this postreperfusion-related impairment of the coronary vasodilating response, CFVR was mainly influenced by stenosis severity and not by residual viability.
在本研究中，我们检测了近期发生心肌梗死（MI）和未发生心肌梗死的患者在经皮腔内冠状动脉成形术（PTCA）前后的狭窄后冠状动脉血流情况，并将其与狭窄严重程度和残余心肌存活情况相关联。
狭窄后冠状动脉血流速度储备（CFVR）已成功用于评估稳定型心绞痛患者的功能性狭窄严重程度。然而，在近期发生心肌梗死的患者中，再灌注心肌受损的冠状动脉血管舒张反应可能会显著改变梗死相关动脉的血流动力学。
在急性心肌梗死后13±7天（均值±标准差），对36例患者以及38例未发生心肌梗死的患者在PTCA前后记录冠状动脉远端血流速度。使用0.014英寸的多普勒导丝，通过远端充血期与基线平均峰值速度之比评估CFVR。通过定量冠状动脉造影分析狭窄严重程度，通过闪烁显像评估梗死面积。
对于造影显示狭窄严重程度相似的情况，发生心肌梗死的患者PTCA前后的CFVR值显著低于未发生心肌梗死的患者：PTCA前分别为1.22±0.26和1.50±0.45（p<0.05），PTCA后分别为1.72±0.43和2.21±0.74（p<0.01）。尽管在两个研究组中，造影成功的PTCA后CFVR均显著增加（p<0.0001），但仍有80%的心肌梗死患者和44%的非心肌梗死患者观察到异常CFVR（≤2.0）（心肌梗死组与非心肌梗死组，p=0.001）。大面积梗死（相对梗死面积≥50%）患者和小面积梗死（相对梗死面积<50%）患者PTCA后的CFVR水平相当（1.6±0.3对1.8±0.5，p=无显著性差异）。在各种因素中，造影狭窄严重程度是两个研究组中CFVR的最重要决定因素。
在近期发生心肌梗死的患者中，PTCA前后的CFVR均显著低于未发生心肌梗死的患者。除了存在这种与再灌注相关的冠状动脉血管舒张反应受损外，CFVR主要受狭窄严重程度影响，而非残余心肌存活情况。
