经食管多普勒超声心动图评估冠状动脉储备。双嘧达莫和腺苷不同给药方式的直接比较。

Assessment of coronary reserve by transoesophageal Doppler echocardiography. Direct comparison between different modalities of dipyridamole and adenosine administration.

作者信息

Kozàkovà M, Palombo C, Pratali L, Bigalli G, Marzilli M, Distante A, L'Abbate A

机构信息

Institute of Clinical Physiology, C.N.R. Pisa, Italy.

出版信息

Eur Heart J. 1997 Mar;18(3):514-23. doi: 10.1093/oxfordjournals.eurheartj.a015274.

DOI:10.1093/oxfordjournals.eurheartj.a015274

PMID:9076391

Abstract

BACKGROUND

This study was undertaken to compare the coronary vasodilator response to different application modalities of intravenous vasodilators, in order to identify the optimal pharmacological protocol for the evaluation of coronary reserve by means of transoesophageal Doppler echocardiography.

METHODS

Blood flow velocity in the left anterior descending artery, coronary vascular resistance and left main coronary artery cross-sectional area were assessed by transoesophageal echo-Doppler during an i.v. adenosine bolus (5 mg), a 5-min adenosine infusion (infusion rate 140 micrograms. kg-1 min-1), and low (0.56 mg.kg-1. 4 min-1), and high-dose (0.84 mg.kg-1.9 min-1) dipyridamole infusions in 10 healthy normals (Group 1) and in 20 patients (Group 2) with either coronary microvascular disease (11 patients) or coronary artery disease (nine patients).

RESULTS

In both groups, the highest flow velocity and the lowest coronary vascular resistance were observed during the adenosine infusion. Flow velocity values and indices of coronary vasodilator capacity observed after the adenosine bolus and the high-dose dipyridamole infusion were very close to those obtained during the adenosine infusion, especially in Group 1. Coronary flow velocity was lower and coronary vascular resistance higher after low-dose dipyridamole, significantly in Group 2. The maximal flow response to the adenosine bolus was observed within a few seconds after the injection, and was very short. The peak response to the adenosine infusion was observed 57 +/- 27 s after its start. The coronary flow velocity response to dipyridamole was dose dependent and differed between Groups 1 and 2.

CONCLUSION

In combination with transoesophageal Doppler echocardiography, a short-lasting adenosine infusion at a rate of 140 micrograms.kg-1.min-1 seems to be preferable to an adenosine bolus and dipyridamole infusion. The effect of the bolus is too short for an accurate measurement of coronary flow velocity, while the dipyridamole infusion, especially at a low dose, induces a submaximal vasodilator response.

摘要

背景

本研究旨在比较静脉血管扩张剂不同应用方式下的冠状动脉扩张反应，以确定经食管多普勒超声心动图评估冠状动脉储备的最佳药理学方案。

方法

在10名健康正常人（第1组）和20名患有冠状动脉微血管疾病（11例）或冠状动脉疾病（9例）的患者（第2组）中，经食管超声多普勒评估静脉注射腺苷推注（5毫克）、5分钟腺苷输注（输注速率140微克·千克⁻¹·分钟⁻¹）以及低剂量（0.56毫克·千克⁻¹·4分钟⁻¹）和高剂量（0.84毫克·千克⁻¹·9分钟⁻¹）双嘧达莫输注期间左前降支动脉血流速度、冠状动脉血管阻力和左主干冠状动脉横截面积。

结果

在两组中，腺苷输注期间观察到最高血流速度和最低冠状动脉血管阻力。腺苷推注和高剂量双嘧达莫输注后观察到的血流速度值和冠状动脉扩张能力指标与腺苷输注期间获得的值非常接近，尤其是在第1组中。低剂量双嘧达莫后冠状动脉血流速度较低且冠状动脉血管阻力较高，在第2组中显著。腺苷推注后数秒内观察到对腺苷推注的最大血流反应，且非常短暂。腺苷输注开始后57±27秒观察到对腺苷输注的峰值反应。冠状动脉血流速度对双嘧达莫的反应呈剂量依赖性，且第1组和第2组之间存在差异。