Haager P K, Klues H G, Schmidt M, vom Dahl J, Hanrath P
Medical Clinic I, Universitätsklinikum (RWTH) Aachen, Germany.
J Cardiovasc Pharmacol. 1999 Jan;33(1):126-34. doi: 10.1097/00005344-199901000-00019.
Little information is available concerning the effects of nitrates and potassium channel openers on local poststenotic blood flow in coronary artery disease (CAD). Combined quantitative digital angiography (QCA) and intracoronary Doppler (IVADO) velocity measurements were used to determine changes in absolute poststenotic blood flow after intracoronary injection of 0.2 mg nitroglycerin and 0.5 mg nicorandil. Quantitative blood flow (QBF) was calculated from average peak-flow velocity (APV) and angiographic cross-sectional area (CSA): QBF (ml/min) = CSA x APV x 0.5. In group I (n = 9), 0.5 mg nicorandil i.c. was identified as optimal to achieve maximal vasodilatation. In patients with CAD (group II, n = 12), i.c. injection of 0.5 mg nicorandil induced a significant increase in poststenotic CSA (+38%) and QBF (+50%). In contrast, 0.2 mg nitroglycerin (group III, n = 12) increases poststenotic CSA (+38%) without a significant change in QBF (+23%). Additional application of nicorandil in these patients induced further significant increases in CSA (+55%) and QBF (+48%) compared with baseline. There were no significant changes in stenosis area. Poststenotic blood flow can be increased by nicorandil after application of nitroglycerin. This effect is most likely mediated by the potassium channel-opening effect of nicorandil. Combined use of QCA and IVADO is a unique approach to measure local poststenotic QBF in patients with CAD.
关于硝酸盐和钾通道开放剂对冠状动脉疾病（CAD）局部狭窄后血流的影响，目前可用信息较少。采用联合定量数字血管造影（QCA）和冠状动脉内多普勒（IVADO）速度测量法，以确定冠状动脉内注射0.2毫克硝酸甘油和0.5毫克尼可地尔后狭窄后绝对血流的变化。定量血流量（QBF）由平均峰值流速（APV）和血管造影横截面积（CSA）计算得出：QBF（毫升/分钟）=CSA×APV×0.5。在第一组（n = 9）中，冠状动脉内注射0.5毫克尼可地尔被确定为实现最大血管扩张的最佳剂量。在CAD患者（第二组，n = 12）中，冠状动脉内注射0.5毫克尼可地尔可使狭窄后CSA显著增加（+38%），QBF显著增加（+50%）。相比之下，0.2毫克硝酸甘油（第三组，n = 12）可使狭窄后CSA增加（+38%），而QBF无显著变化（+23%）。与基线相比，在这些患者中额外应用尼可地尔可使CSA进一步显著增加（+55%），QBF进一步显著增加（+48%）。狭窄面积无显著变化。应用硝酸甘油后，尼可地尔可增加狭窄后血流。这种作用很可能是由尼可地尔的钾通道开放作用介导的。QCA和IVADO联合使用是测量CAD患者局部狭窄后QBF的独特方法。
