Lekakis J P, Papamichael C M, Vemmos C N, Voutsas A A, Stamatelopoulos S F, Moulopoulos S D
Department of Clinical Therapeutics, Alexandra University Hospital, Athens, Greece.
J Am Coll Cardiol. 1998 Mar 1;31(3):541-6. doi: 10.1016/s0735-1097(97)00542-1.
We sought to determine endothelium-dependent vasodilator function in the brachial artery of patients with microvascular angina pectoris.
Previous studies suggest the presence of endothelial dysfunction of the coronary microcirculation in patients with microvascular angina pectoris. It is not known whether endothelial dysfunction in these patients is a generalized process or whether it is confined to the coronary microcirculation only.
In 11 women (mean [+/-SD] age 60.1 +/- 7.8 years) with microvascular angina (anginal pain, normal epicardial coronary arteries, positive exercise stress test), endothelium-dependent vasodilation was assessed in the brachial artery by measuring the change in brachial artery diameter in response to hyperemic flow. Results were compared with 11 age- and gender-matched patients with known three-vessel coronary artery disease and 11 age- and gender-matched healthy control subjects. In all subjects, the intima-media thickness (IMT) of the common carotid artery was also measured.
Flow-mediated dilation (FMD) was comparable in patients with microvascular angina and coronary artery disease (1.9 +/- 2.5% vs. 3.3 +/- 3.3%, p = NS) but was significantly lower in patients with microvascular angina than in healthy control subjects (1.9 +/- 2.5% vs. 7.9 +/- 3%, p < 0.05). IMT was significantly lower in patients with microvascular angina than in those with coronary artery disease (0.64 +/- 0.08 vs. 1.0 +/- 0.28 mm, p < 0.05) and was comparable between patients with microvascular angina pectoris and healthy control subjects (0.64 +/- 0.08 vs. 0.56 +/- 0.14 mm, p = NS). IMT > or = 0.8 mm was observed in 1 of 11 patients with microvascular angina, 1 of 11 control subjects and 10 of 11 patients with coronary artery disease.
These findings suggest that endothelial dysfunction in microvascular angina is a generalized process that also involves the peripheral conduit arteries and is similar to that observed in atherosclerotic disease. IMT could be helpful in discriminating patients with microvascular angina and atherosclerotic coronary artery disease.
我们试图确定微血管性心绞痛患者肱动脉的内皮依赖性血管舒张功能。
先前的研究表明微血管性心绞痛患者存在冠状动脉微循环内皮功能障碍。尚不清楚这些患者的内皮功能障碍是一个全身性过程还是仅局限于冠状动脉微循环。
对11名微血管性心绞痛女性患者（平均年龄[±标准差]60.1±7.8岁，有胸痛症状，心外膜冠状动脉正常，运动负荷试验阳性），通过测量肱动脉直径对充血血流的变化来评估肱动脉的内皮依赖性血管舒张功能。将结果与11名年龄和性别匹配的已知三支冠状动脉疾病患者以及11名年龄和性别匹配的健康对照者进行比较。在所有受试者中，还测量了颈总动脉的内膜中层厚度（IMT）。
微血管性心绞痛患者与冠状动脉疾病患者的血流介导的血管舒张（FMD）相当（1.9±2.5%对3.3±3.3%，p=无显著性差异），但微血管性心绞痛患者的FMD显著低于健康对照者（1.9±2.5%对7.9±3%，p<0.05）。微血管性心绞痛患者的IMT显著低于冠状动脉疾病患者（0.64±0.08对1.0±0.28mm，p<0.05），且微血管性心绞痛患者与健康对照者之间的IMT相当（0.64±0.08对0.56±0.14mm，p=无显著性差异）。11名微血管性心绞痛患者中有1名、11名对照者中有1名以及11名冠状动脉疾病患者中有10名观察到IMT≥0.8mm。
这些发现表明，微血管性心绞痛中的内皮功能障碍是一个全身性过程，也累及外周传导动脉，且与动脉粥样硬化疾病中观察到的情况相似。IMT有助于区分微血管性心绞痛患者和动脉粥样硬化性冠状动脉疾病患者。
