在患有扩散性动脉样硬化但"正常"冠状动脉血管学的患者中出现异常的表心冠状动脉抵抗
B De Bruyne1, F Hersbach, N H Pijls
1Cardiovascular Center Aalst, Aalst, Belgium. bernard.de.bruyne@olvz-aalst.be
Circulation
|November 14, 2001
概括
扩散性冠状动脉样硬化,即使没有明显的阻塞,也会降低冠状动脉的血流和压力. 这一发现影响了对心肌缺血和治疗决策的理解.
科学领域:
- 心血管医学 心血管医学
- 干预心脏病学 干预心脏病学
- 生理学 生理学 生理学
背景情况:
- 血管造影经常错过扩散性冠状动脉样硬化,这是冠状动脉疾病中常见的过程.
- 非阻塞性冠状动脉通常被认为具有正常的流动力学.
- 动脉样硬化是一种扩散性疾病,影响整个动脉长度,而不仅仅是焦点狭窄症.
研究的目的:
- 调查冠状动脉疾病患者的非静脉性冠状动脉是否表现出压力和流量减少.
- 为量化由于扩散性动脉样硬化的非阻塞性冠状动脉段的压力下降.
- 确定扩散性动脉样硬化的对冠状动脉导电性和分数流量储备 (FFR) 的影响.
主要方法:
- 在非静脉动脉中测量冠状动脉压力和分数流量储备 (FFR).
- 健康个体 (I组) 与冠状动脉疾病患者 (II组) 的比较.
- 对静止状态和高血压期间压力梯度的分析,以评估冠状动脉阻力.
主要成果:
- 冠状动脉疾病患者的非静脉动脉与健康对照人群相比,显示压力梯度明显更高.
- 在冠状动脉疾病患者的非静脉动脉中,分数流量储备 (FFR) 显著降低,表明抗性增加.
- 很大一部分非静脉动脉的FFR值低于正常值,其中一些达到可诱导性缺血的值.
结论:
- 没有焦点狭窄的扩散性冠状动脉样硬化会导致沿冠状动脉长度持续下降的压力.
- 这种持续下降的压力导致心肌缺血.
- 扩散性动脉样硬化在非静脉细分的存在对干预性心脏病学的决策产生影响.
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