永久性双腔起搏对症状性肥厚型心肌病心肌灌注的影响。

Effects of permanent dual chamber pacing on myocardial perfusion in symptomatic hypertrophic cardiomyopathy.

作者信息

Posma J L, Blanksma P K, Van Der Wall E E, Vaalburg W, Crijns H J, Lie K I

机构信息

Department of Cardiology, Thoraxcentre, University Hospital Groningen, Netherlands.

出版信息

Heart. 1996 Oct;76(4):358-62. doi: 10.1136/hrt.76.4.358.

DOI:10.1136/hrt.76.4.358

PMID:8983685

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC484550/

Abstract

OBJECTIVE

Angina and the presence of myocardial ischaemia are common in hypertrophic cardiomyopathy. Dual chamber pacing results in clinical improvement in these patients. This study evaluates the effects of permanent dual chamber pacing on absolute regional myocardial perfusion and perfusion reserve.

SETTING

University hospital.

PATIENTS AND DESIGN

Six patients with hypertrophic cardiomyopathy and severe symptoms of angina received a dual chamber pacemaker. Absolute myocardial regional perfusion and perfusion reserve (dipyridamole 0.56 mg/kg) were measured by dynamic positron emission tomography with 13N-ammonia both during sinus rhythm and 3 months after pacemaker insertion. Results were compared with those from 28 healthy volunteers.

RESULTS

Pacing resulted in a reduction of anginal complaints and a reduction in intraventricular pressure gradient from 65 (SD 30) mm Hg to 19 (10) mm Hg. During sinus rhythm, baseline perfusion was higher in patients with hypertrophic cardiomyopathy than controls (184 (31) v 106 (26) ml/min/100 g, P < 0.01), and perfusion reserve was lower (1.6 (0.4) v 2.8 (1.0), P < 0.05). During pacing myocardial perfusion decreased to 130 (27) ml/min/100 g (P < 0.05), with variable responses in terms of perfusion reserve. Pacing caused a redistribution of myocardial stress perfusion and perfusion reserve. The coefficient of regional variation of myocardial stress perfusion decreased from 19.7 (7.0)% to 14.6 (3.9)% during pacing (12.9 (3.8)% in controls, P < 0.01). The coefficient of regional variation of perfusion reserve decreased from 16.7 (6.6)% to 11.4 (2.6)% during pacing (9.8 (4.1)% in controls, P < 0.01).

CONCLUSIONS

Pacing caused a decrease of resting left ventricular myocardial blood flow and blood flow during pharmacologically induced coronary vasodilatation. Although global perfusion reserve remained unchanged, myocardial perfusion reserve became more homogeneously distributed.

摘要

目的

心绞痛及心肌缺血在肥厚型心肌病中很常见。双腔起搏可使这些患者的临床症状得到改善。本研究评估永久性双腔起搏对绝对局部心肌灌注及灌注储备的影响。

地点

大学医院。

患者与设计

6例有肥厚型心肌病且有严重心绞痛症状的患者植入了双腔起搏器。在窦性心律时及起搏器植入后3个月，采用13N-氨动态正电子发射断层扫描测量绝对心肌局部灌注及灌注储备（双嘧达莫0.56mg/kg）。将结果与28名健康志愿者的结果进行比较。

结果

起搏使心绞痛症状减轻，室内压梯度从65（标准差30）mmHg降至19（10）mmHg。在窦性心律时，肥厚型心肌病患者的基线灌注高于对照组（184（31）对106（26）ml/min/100g，P<0.01），灌注储备较低（1.6（0.4）对2.8（1.0），P<0.05）。起搏期间心肌灌注降至130（27）ml/min/100g（P<0.05），灌注储备的反应各异。起搏导致心肌应激灌注及灌注储备重新分布。起搏期间心肌应激灌注的区域变异系数从19.7（7.0）%降至14.6（3.9）%（对照组为12.9（3.8）%，P<0.01）。起搏期间灌注储备的区域变异系数从16.7（6.6）%降至11.4（2.6）%（对照组为9.8（4.1）%，P<0.01）。