慢性的な全冠動脈閉塞における微血管機能障害
G S Werner1, M Ferrari, B M Richartz
1Clinic for Internal Medicine III, Friedrich-Schiller-University Jena, Erlanger Allee 101, Jena, Germany. gerald.werner@med.uni-jena.de
Circulation
|September 6, 2001
まとめ
微血管機能不全は,慢性完全冠動脈閉塞 (TCO) の患者の半数以上,特に糖尿病や高血圧の患者に影響します. 冠動脈流速準備 (CFVR) と断片流量準備 (FFR) の組み合わせは,TCO血管新生手術後の正確な評価に不可欠です.
科学分野:
- 心血管医学 心血管医学
- 介入性心臓病学 介入性心臓病学
- 冠動脈疾患 冠動脈疾患 冠動脈疾患
背景:
- 微血管機能不全は,上心筋狭窄症なしに冠動脈フローの準備が減少した特徴です.
- この研究では,慢性的な全冠動脈閉塞 (TCOs) のマイクロ血管機能障害の罹患率と影響を調査しました.
研究 の 目的:
- TCOsにおけるマイクロ血管機能障害の有病率を決定する.
- マイクロ血管機能障害と地域性心筋機能の関係を評価する.
- TCOsにおける冠動脈流動速度準備 (CFVR) と分流準備 (FFR) の有用性を評価する.
主な方法:
- 42人の患者でTCOのリカナライゼーションとステントを施しました.
- 冠動脈内ドップラーで測定された冠動脈流動速度予備量 (CFVR).
- 27人の患者のサブセットで記録された分断フローリザーブ (FFR).
- CFVRは21人の患者で24時間後に再評価されました.
主要な成果:
- 患者の55%がCFVRの低下を示した (<2.0).
- サブグループでは,52%がCFVRが低下し,FFRが非有意 (>=0.75) であったが,これはマイクロ血管機能不全を示している.
- 微血管機能不全は,糖尿病および/または高血圧の患者でより一般的であった.
- CFVRとFFRは相関が薄かった (r=0.03).
結論:
- 微小血管機能不全は,TCOs (55%) で,地域的な心筋機能に関係なく一般的です.
- 糖尿病と高血圧は,マイクロ血管機能不全の増加と関連しています.
- CFVRもFFRも単独では,TCOにおける血管新生手術の結果の評価に十分ではありません.
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