Uren N G, Crake T, Tousoulis D, Seydoux C, Davies G J, Maseri A
Department of Medicine, Hammersmith Hospital, London, United Kingdom.
Heart. 1997 Jul;78(1):61-7. doi: 10.1136/hrt.78.1.61.
To study the vasomotor response (cold pressor/basal flow) in myocardium perfused entirely by collaterals, using the reflex sympathetic stimulation of cold pressor stress.
Regional myocardial blood flow was measured in collateral dependent and in remote myocardium using positron emission tomography with 15O water at basal and at cold pressor stress. Regional ischaemia was measured with 18F-fluorodeoxyglucose (FDG).
Nine patients (mean (SD) age 53 (6) years) with an occluded coronary artery supplied entirely by collaterals from other angiographically normal arteries.
In remote myocardium, basal and cold pressor flow were 0.99 (0.26) and 1.46 (0.60) ml/min/g (P < 0.05), respectively, a myocardial vasomotor response of 1.46 (0.45). In collateral dependent myocardium, basal and cold pressor flow were 0.91 (0.20) and 0.87 (0.35) ml/min/g, respectively (the latter value, P < 0.05 v remote region), a myocardial vasomotor response of 0.97 (0.43) (P < 0.05 v remote region). The myocardial vascular resistance (mean arterial pressure/flow) during cold pressor was higher in the collateral dependent than in remote myocardium, at 147.0 (61.1) and 85.6 (32.3) mm Hg.min.g/ml (P < 0.05), respectively, but with no relative increase in FDG uptake.
In contrast to the decrease in myocardial resistance in remote myocardium with cold pressor, an increase was observed in collateral dependent myocardium suggesting a vasoconstrictor response in resistive vessels, without demonstrable myocardial ischaemia.
利用冷加压应激的反射性交感神经刺激，研究完全由侧支循环灌注的心肌中的血管舒缩反应（冷加压/基础血流）。
在基础状态和冷加压应激状态下，使用含15O水的正电子发射断层扫描技术，测量侧支循环依赖心肌和远隔心肌的局部心肌血流。用18F-氟脱氧葡萄糖（FDG）测量局部缺血情况。
9例患者（平均（标准差）年龄53（6）岁），其闭塞的冠状动脉完全由其他血管造影正常的动脉的侧支循环供血。
在远隔心肌中，基础血流和冷加压血流分别为0.99（0.26）和1.46（0.60）ml/（min·g）（P<0.05），心肌血管舒缩反应为1.46（0.45）。在侧支循环依赖心肌中，基础血流和冷加压血流分别为0.91（0.20）和0.87（0.35）ml/（min·g）（后一数值与远隔区域相比，P<0.05），心肌血管舒缩反应为0.97（0.43）（与远隔区域相比，P<0.05）。冷加压期间，侧支循环依赖心肌的心肌血管阻力（平均动脉压/血流）高于远隔心肌，分别为147.0（61.1）和85.6（32.3）mmHg·min·g/ml（P<0.05），但FDG摄取无相对增加。
与冷加压时远隔心肌的心肌阻力降低相反，侧支循环依赖心肌出现增加，提示阻力血管有血管收缩反应，且未显示有心肌缺血。
