肥厚型心肌病和左心室功能不全患者的冠状动脉血管扩张储备受损。

Coronary vasodilator reserve is impaired in patients with hypertrophic cardiomyopathy and left ventricular dysfunction.

作者信息

Lorenzoni R, Gistri R, Cecchi F, Olivotto I, Chiriatti G, Elliott P, McKenna W J, Camici P G

机构信息

MRC Clinical Sciences Centre and Royal Postgraduate Medical School, Hammersmith Hospital, London, UK.

出版信息

Am Heart J. 1998 Dec;136(6):972-81. doi: 10.1016/s0002-8703(98)70152-8.

DOI:10.1016/s0002-8703(98)70152-8

PMID:9842009

Abstract

BACKGROUND

We tested the hypothesis that a reduced delivery of blood to the myocardium is involved in the development of systolic dysfunction of patients with hypertrophic cardiomyopathy (HCM).

METHODS AND RESULTS

Eighty-four patients with HCM (62 men, age 43 +/- 12 years) were studied. Left ventricular dimensions and function (fractional shortening) were evaluated by 2-dimensional echocardiography. Myocardial blood flow (MBF) was measured by N13 -ammonia or O15 -water and positron emission tomography at baseline and after dipyridamole; coronary vasodilator reserve (CVR) was calculated as dipyridamole/baseline MBF. Patients with HCM in advanced New York Heart Association (NYHA) classes had lower dipyridamole MBF (NYHA class I = 1.57 +/- 0.64 vs class II = 1.52 +/- 0.58 vs class III = 0.96 +/- 0.32 mL/min per gram; analysis of variance, P <.05) and CVR (NYHA class I = 1.93 +/- 0.64 vs class II = 1.69 +/- 0.54 vs class III = 1.40 +/- 0.43; analysis of variance, P <.05). A positive linear correlation between fractional shortening and dipyridamole MBF was demonstrated (R = 0.23, P <.05), and patients with abnormal fractional shortening had lower dipyridamole MBF (1.07 +/- 0.43 vs 1.58 +/- 0.62 mL/min per gram, P <.01).

CONCLUSIONS

Systolic dysfunction in HCM may be caused by a more severe alteration of the coronary vasodilator capacity.

摘要

背景

我们检验了这样一个假设，即心肌供血减少参与了肥厚型心肌病（HCM）患者收缩功能障碍的发生发展。

方法与结果

对84例HCM患者（62例男性，年龄43±12岁）进行了研究。通过二维超声心动图评估左心室大小和功能（缩短分数）。在基线和双嘧达莫给药后，采用N13-氨或O15-水及正电子发射断层扫描测量心肌血流量（MBF）；计算冠状动脉血管扩张储备（CVR），即双嘧达莫/基线MBF。纽约心脏协会（NYHA）心功能分级处于晚期的HCM患者双嘧达莫MBF较低（NYHAⅠ级=1.57±0.64 vsⅡ级=1.52±0.58 vsⅢ级=0.96±0.32 mL/（min·g）；方差分析，P<.05），CVR也较低（NYHAⅠ级=1.93±0.64 vsⅡ级=1.69±0.54 vsⅢ级=1.40±0.43；方差分析，P<.05）。缩短分数与双嘧达莫MBF之间呈正线性相关（R=0.23，P<.05），缩短分数异常的患者双嘧达莫MBF较低（1.07±0.43 vs 1.58±0.62 mL/（min·g），P<.01）。