Yokoyama I, Ohtake T, Momomura S, Nishikawa J, Sasaki Y, Omata M
Second Department of Internal Medicine, University of Tokyo, Japan.
Circulation. 1996 Dec 15;94(12):3232-8. doi: 10.1161/01.cir.94.12.3232.
Reduced coronary flow reserve (CFR) in hypercholesterolemic patients without evidence of ischemia has been reported. However, it remains uncertain whether this abnormality occurs without overt coronary atherosclerosis. This study aimed to clarify whether CFR is impaired even in anatomically normal coronary arteries in hypercholesterolemic patients and to compare CFR between familial hypercholesterolemic (FH) patients and secondary hypercholesterolemic (SH) patients.
Twenty-two patients with hypercholesterolemia (11 FH, 11 SH) and 11 control subjects were studied. Baseline myocardial blood flow (MBF) and MBF during dipyridamole loading were measured in segments perfused by angiographically normal coronary arteries with the use of positron emission tomography and 13N-ammonia, and CFR was calculated. Baseline MBF (mL/min per 100 g heart wt) in FH (81.3 +/- 31.4) and SH (70.0 +/- 20.7) patients was not different from that in control subjects (75.0 +/- 34.9). However, MBF during dipyridamole loading was significantly lower in FH patients (129 +/- 19.1) than in control subjects (322 +/- 174, P < .01) and SH patients (210 +/- 71.2, P < .01). CFR in FH patients (1.59 +/- 0.41) was also significantly lower compared with both control subjects (4.22 +/- 1.42, P < .01) and SH patients (3.00 +/- 0.96, P < .01). CFR in SH patients was also significantly lower than that in control subjects (P < .05). CFR correlated significantly with both plasma total cholesterol (r = .67, P < .01) and LDL cholesterol concentrations (r = .69, P < .01).
CFR was decreased even in anatomically normal coronary arteries in hypercholesterolemic patients. This abnormality was more prominent in FH patients.
有报道称，在无缺血证据的高胆固醇血症患者中，冠状动脉血流储备（CFR）降低。然而，这种异常是否在无明显冠状动脉粥样硬化的情况下发生仍不确定。本研究旨在阐明高胆固醇血症患者即使在解剖结构正常的冠状动脉中CFR是否受损，并比较家族性高胆固醇血症（FH）患者和继发性高胆固醇血症（SH）患者的CFR。
对22例高胆固醇血症患者（11例FH，11例SH）和11例对照者进行了研究。使用正电子发射断层扫描和13N-氨，在血管造影显示正常的冠状动脉灌注节段中测量静息心肌血流量（MBF）和双嘧达莫负荷试验期间的MBF，并计算CFR。FH患者（81.3±31.4）和SH患者（70.0±20.7）的静息MBF（每100g心脏重量的mL/min）与对照者（75.0±34.9）无差异。然而，FH患者双嘧达莫负荷试验期间的MBF（129±19.1）显著低于对照者（322±174，P<.01）和SH患者（210±71.2，P<.01）。FH患者的CFR（1.59±0.41）也显著低于对照者（4.22±1.42，P<.01）和SH患者（3.00±0.96，P<.01）。SH患者的CFR也显著低于对照者（P<.05）。CFR与血浆总胆固醇（r=.67，P<.01）和低密度脂蛋白胆固醇浓度（r=.69，P<.01）均显著相关。
高胆固醇血症患者即使在解剖结构正常的冠状动脉中CFR也降低。这种异常在FH患者中更为突出。
