Beleslin B D, Ostojic M, Djordjevic-Dikic A, Nedeljkovic M, Stankovic G, Stojkovic S, Babic R, Stepanovic J, Saponjski J, Marinkovic J, Vasiljevic-Pokrajcic Z, Kanjuh V
Department of Diagnostic and Catheterization Laboratories, University Institute for Cardiovascular Disease, Belgrade, Yugoslavia.
Eur Heart J. 1997 Jul;18(7):1166-74. doi: 10.1093/oxfordjournals.eurheartj.a015413.
The aim of this study was to evaluate simultaneously echocardiographic, haemodynamic and angiographic changes that occur during adenosine and dipyridamole infusion, in patients with one-vessel coronary artery stenosis. This would assess whether deterioration in left ventricular haemodynamics during vasodilator agent infusion is influenced by vasodilation per se, or the development of myocardial ischaemia.
We performed adenosine (140 micrograms.kg-1.min-1 over 4 min) and dipyridamole (up to 0.84 mg.kg-1 over 10 min) stress echocardiography tests, together with angiographic and haemodynamic assessment, in 26 patients undergoing elective coronary angioplasty. In 12 of 26 patients, adenosine and dipyridamole tests were repeated 24 h after angioplasty. The criterion for echocardiography test positivity was the appearance of a new transient regional wall motion abnormality. Coronary angiograms were analysed with quantitative coronary arteriography. Adenosine and dipyridamole induced regional dysfunction in 18/26 (69%) and 14/26 (54%) patients before angioplasty, respectively (P = ns). In the echocardiography-positive patients, the percent diameter stenosis was significantly (P < 0.05) tighter stenosis than in the echocardiography-negative patients (adenosine, 66.6 +/- 8.3% vs 58.0 +/- 8.9%; dipyridamole, 69.2 +/- 7.1% vs 57.7 +/- 7.6%). During both tests, left ventricular end-diastolic pressure significantly increased (P < 0.05) in echocardiography-positive patients (adenosine, 9.8 +/- 2.7 mmHg to 13.5 +/- 4.1 mmHg; dipyridamole, 10.1 +/- 2.8 mmHg to 14.1 +/- 4.3 mmHg), but not in echocardiography-negative patients. In the patients who had undergone successful angioplasty (reduction to < 50% diameter stenosis), both adenosine and dipyridamole confirmed the arteriographic success of the procedure (echocardiography negative in all patients). In this group of patients, no significant change was observed in left ventricular end-diastolic pressure during adenosine or dipyridamole infusion.
Intravenous infusion of either adenosine or dipyridamole was accompanied by an obvious increase in left ventricular end-diastolic pressure only in patients with induced wall motion abnormalities. Coronary vasodilation per se has no significant effect on left ventricular end-diastolic pressure when no ischaemia is induced, disproving any clinically significant 'erectile' and adverse effects of coronary vasodilation per se.
本研究旨在同时评估单支冠状动脉狭窄患者在输注腺苷和双嘧达莫过程中发生的超声心动图、血流动力学及血管造影变化。这将评估血管扩张剂输注期间左心室血流动力学恶化是受血管扩张本身影响，还是受心肌缺血发展的影响。
我们对26例接受择期冠状动脉成形术的患者进行了腺苷（4分钟内140微克·千克⁻¹·分钟⁻¹）和双嘧达莫（10分钟内达0.84毫克·千克⁻¹）负荷超声心动图检查，同时进行血管造影和血流动力学评估。26例患者中有12例在血管成形术后24小时重复进行了腺苷和双嘧达莫试验。超声心动图检查阳性标准为出现新的短暂性局部室壁运动异常。冠状动脉造影采用定量冠状动脉造影术进行分析。血管成形术前，腺苷和双嘧达莫分别在18/26（69%）和14/26（54%）的患者中诱发了局部功能障碍（P=无显著性差异）。在超声心动图检查阳性的患者中，狭窄直径百分比显著（P<0.05）比超声心动图检查阴性的患者更严重（腺苷，66.6±8.3%对58.0±8.9%；双嘧达莫，69.2±7.1%对57.7±7.6%）。在两项检查期间，超声心动图检查阳性的患者左心室舒张末期压力显著升高（P<0.05）（腺苷，9.8±2.7毫米汞柱升至13.5±4.1毫米汞柱；双嘧达莫，10.1±2.8毫米汞柱升至14.1±4.3毫米汞柱），而超声心动图检查阴性的患者则没有。在血管成形术成功（狭窄直径降至<50%）的患者中，腺苷和双嘧达莫均证实了手术的血管造影成功（所有患者超声心动图检查均为阴性）。在这组患者中，输注腺苷或双嘧达莫期间左心室舒张末期压力未观察到显著变化。
仅在诱发室壁运动异常的患者中，静脉输注腺苷或双嘧达莫会伴随左心室舒张末期压力明显升高。在未诱发缺血时，冠状动脉扩张本身对左心室舒张末期压力无显著影响，这反驳了冠状动脉扩张本身任何具有临床意义的“勃起”及不良反应。
