Lupi A, Buffon A, Finocchiaro M L, Conti E, Maseri A, Crea F
Istituto di Cardiologia, Università Cattolica del Sacro Cuore, Rome, Italy.
Eur Heart J. 1997 Apr;18(4):614-7. doi: 10.1093/oxfordjournals.eurheartj.a015305.
In order to ascertain whether human adenosine-induced dilatation of epicardial arteries is direct or flow-mediated, we compared the effects of intracoronary adenosine infusion on epicardial coronary arteries with those produced by dipiridamole, a selective arteriolar vasodilator.
In 24 patients with angiographically normal coronary arteries, coronary blood flow velocity was measured by a Doppler wire during intracoronary infusion of adenosine or dipyridamole, which is known to increase intramyocardial adenosine concentration. Coronary angiograms were obtained at baseline and immediately after the end of each infusion period; coronary diameters 5 mm distal to the wire tip were measured by computer-assisted quantitative coronary angiography. Peak coronary blood flow velocities during adenosine or dipyridamole infusions were similar (52.0 +/- 15.5 and 47.9 +/- 24.2 cm.s-1, P = ns). Coronary diameters immediately after adenosine and dipyridamole infusions were similar and both higher than that at baseline (2.80 +/- 0.63 and 2.86 +/- 0.64 vs 2.44 +/- 0.69 mm, P < 0.05). The absolute and percentage increases of coronary artery diameters in response to adenosine were highly correlated to coronary blood flow velocity (R = 0.622, intercept -0.10 +/- 0.14, P = 0.002 and R = 0.617, intercept -15.2 +/- 9.9, P = 0.001, respectively); similar correlations were found in response to dipyridamole (R = 0.708, intercept -0.44 +/- 0.19, P < 0.001 and R = 0.649, intercept -13.5 +/- 8.7, P < 0.001, respectively). Finally the absolute and percentage changes of coronary artery diameters caused by adenosine were highly correlated to those caused by dipyridamole (R = 0.840 P < 0.001 and R = 0.836, P < 0.001 respectively).
A significant correlation exists between epicardial coronary vasodilation and coronary blood flow velocity during intracoronary adenosine infusion, thus suggesting that epicardial coronary vasodilation induced by adenosine is predominantly flow-mediated rather than direct. This conclusion is supported by the observation that similar findings were obtained using dipyridamole, which can only dilate epicardial coronary arteries indirectly, through the increase in coronary blood flow velocity caused by the inhibition of intramyocardial adenosine re-uptake.
为了确定人体中腺苷诱导的心外膜动脉扩张是直接作用还是血流介导的，我们比较了冠状动脉内输注腺苷与双嘧达莫（一种选择性小动脉血管扩张剂）对心外膜冠状动脉的影响。
在24例冠状动脉造影正常的患者中，在冠状动脉内输注腺苷或双嘧达莫（已知可增加心肌内腺苷浓度）期间，用多普勒导丝测量冠状动脉血流速度。在基线时以及每个输注期结束后立即进行冠状动脉造影；通过计算机辅助定量冠状动脉造影测量导丝尖端远端5mm处的冠状动脉直径。腺苷或双嘧达莫输注期间的冠状动脉血流速度峰值相似（分别为52.0±15.5和47.9±24.2cm·s⁻¹，P=无显著性差异）。腺苷和双嘧达莫输注后立即的冠状动脉直径相似，且均高于基线时（分别为2.80±0.63和2.86±0.64 vs 2.44±0.69mm，P<0.05）。腺苷引起的冠状动脉直径的绝对增加和百分比增加与冠状动脉血流速度高度相关（分别为R=0.622，截距-0.10±0.14，P=0.002和R=0.61
