Piek J J, van Liebergen R A, Koch K T, de Winter R J, Peters R J, David G K
Department of Cardiology, Academic Medical Center, Amsterdam, Netherlands.
Circulation. 1997 Jul 1;96(1):106-15. doi: 10.1161/01.cir.96.1.106.
The pharmacological responsiveness of the coronary collateral circulation in humans has been studied only by indirect means.
Patients with one-vessel disease and recruitable (n = 14) or spontaneously visible (n = 24) collateral vessels were studied during coronary angioplasty. Collateral flow in the recipient coronary artery was determined with a 0.014-in Doppler guide wire during balloon coronary occlusion and expressed as the diastolic blood flow velocity integral (dVi). Collateral blood flow velocity, mean aortic pressure (Pao), and coronary wedge pressure (Pw) were used to calculate the collateral vascular resistance index: Rcoll = (Pao-Pw)/ dVi (mm Hg/cm) and the peripheral vascular resistance index of the recipient coronary artery: R4 = Pw/dVi (mm Hg/cm). Adenosine (12 to 18 micrograms) and nitroglycerin (0.2 mg) were injected as a bolus in the donor coronary artery during subsequent balloon inflations to assess their effect on these hemodynamic variables. The administration of adenosine or nitroglycerin in patients with recruitable collateral vessels did not induce a change in dVi and Pw/Pao ratio. In patients with spontaneously visible collateral vessels, dVi increased from 8.0 +/- 4.5 to 10.8 +/- 8.0 cm (P = .01) after adenosine and from 7.4 +/- 4.5 to 10.3 +/- 6.9 cm (P = .003) after nitroglycerin. The Pw/Pao ratio remained unchanged after adenosine and nitroglycerin. Rcoll decreased from 10.3 +/- 9.5 to 8.6 +/- 8.5 mm Hg/cm (P = .01) after adenosine and from 11.6 +/- 10.4 to 8.3 +/- 8.9 mm Hg/cm (P < .001) after nitroglycerin. R4 decreased from 7.7 +/- 5.5 to 5.9 +/- 5.1 mm Hg/cm (P < .001) after adenosine and from 8.4 +/- 6.6 to 7.1 +/- 7.2 mm Hg/cm (P = .01) after nitroglycerin.
Coronary collateral blood flow can be increased with adenosine and nitroglycerin in patients with one-vessel disease and spontaneously visible collateral vessels, which is in contrast to patients with recruitable collateral vessels. This effect is the result of a reduction in the collateral vascular resistance and peripheral vascular resistance of the recipient coronary artery.
人类冠状动脉侧支循环的药理反应性仅通过间接方法进行了研究。
在冠状动脉血管成形术期间，对患有单支血管疾病且有可诱导性（n = 14）或自发性可见（n = 24）侧支血管的患者进行了研究。在球囊冠状动脉闭塞期间，使用0.014英寸的多普勒导丝测定接受冠状动脉中的侧支血流，并表示为舒张期血流速度积分（dVi）。利用侧支血流速度、平均主动脉压（Pao）和冠状动脉楔压（Pw）来计算侧支血管阻力指数：Rcoll =（Pao - Pw）/ dVi（mmHg/cm）以及接受冠状动脉的外周血管阻力指数：R4 = Pw/dVi（mmHg/cm）。在随后的球囊充盈过程中，将腺苷（12至18微克）和硝酸甘油（0.2毫克）作为推注剂注入供血冠状动脉，以评估它们对这些血流动力学变量的影响。在有可诱导性侧支血管的患者中，给予腺苷或硝酸甘油并未引起dVi和Pw/Pao比值的变化。在有自发性可见侧支血管的患者中，腺苷给药后dVi从8.0±4.5增加至10.8±8.0厘米（P = 0.01），硝酸甘油给药后从7.4±4.5增加至10.3±6.9厘米（P = 0.003）。腺苷和硝酸甘油给药后，Pw/Pao比值保持不变。腺苷给药后，Rcoll从10.3±9.5降至8.6±8.5 mmHg/cm（P = 0.01），硝酸甘油给药后从11.6±10.4降至8.3±8.9 mmHg/cm（P < 0.001）。腺苷给药后，R4从7.7±5.5降至5.9±5.1 mmHg/cm（P < 0.001），硝酸甘油给药后从8.4±6.6降至7.1±7.2 mmHg/cm（P = 0.01）。
在患有单支血管疾病且有自发性可见侧支血管的患者中，腺苷和硝酸甘油可增加冠状动脉侧支血流，这与有可诱导性侧支血管的患者形成对比。这种效应是接受冠状动脉的侧支血管阻力和外周血管阻力降低的结果。
