Decreased coronary flow reserve in hypertrophic cardiomyopathy is related to remodeling of the coronary microcirculation
Decreased coronary flow reserve in hypertrophic cardiomyopathy is related to remodeling of the coronary microcirculation
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DOI：
10.1161/01.cir.97.3.230
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发表时间：
1998-01-27
期刊：
影响因子：
37.8
通讯作者：
Serruys, PW
中科院分区：
文献类型：
--
作者：
Krams, R;Kofflard, MJM;Serruys, PW
心肌缺血是肥厚型心肌病（HCM）常见的并发症，但无心外膜狭窄的证据。本研究对HCM心肌缺血的发生与冠状动脉微循环重构有关的假设进行了评价。方法和结果：HCM患者舒张末期室间隔厚度显著增加（25.8 ± 2.9 mm）与心脏移植受者（对照受试者：11.4 ± 3.0 mm; P < 0.05）相比。虽然两组的冠状动脉左前降支直径相似（3.0 ± 0.8与3.0 ± 0.5 mm，P = NS），冠状动脉阻力储备（CRR = CRR基础/CR充血），校正血管外压迫（舒张末期左心室压）在HCM中降低至1.5 ± 0.6（P <0.05;对照组，2.6 ± 0.8）。与30 +/- 4%; P <0.05），毛细血管密度有下降趋势（从1824 +/- 424降至1445 +/- 513/mm 2，p = 0.11）。根据公式CRR = 0.1 AL - 0.45，CRR与标准化AL线性相关（r = 0.57; P <0.05）。进一步分析显示，CRR、AL和毛细血管密度均与肥厚程度呈线性相关。结论CRR下降与冠状动脉微循环改变有关。CRR的降低和冠状动脉微循环的这些变化都与肥厚的程度有关。所有这些因素都可能导致该患者组中众所周知的缺血发生。
Background-Ischemia occurs frequently in hypertrophic cardiomyopathy (HCM) without evidence of epicardial stenosis, This study evaluates the hypothesis that the occurrence of ischemia in HCM is related to remodeling of the coronary microcirculation,Methods and Results-End-diastolic septal wall thickness was significantly increased in patients with HCM (25.8 +/- 2.9 mm) in comparison with cardiac transplant recipients (control subjects: 11.4 +/- 3.0 mm; P < 0.05). Although the diameter of the left anterior descending coronary artery was similar in both groups (3.0 +/- 0.8 versus 3.0 +/- 0.5 mm, P = NS), the coronary resistance reserve (CRR = CRRbasal/CRRhyperemic), corrected for extravascular compression (end-diastolic left ventricular pressure), was reduced to 1.5 +/- 0.6 in HCM (P < .05; control, 2.6 +/- 0.8), Arteriolar lumen (AL) divided by wall area was lower in HCM (21 +/- 5%. versus 30 +/- 4%; P < .05), and capillary density tended to decrease (from 1824 +/- 424 to 1445 +/- 513 per mm(2), p = .11) in HCM. CRR was linearly related to normalized AL according to the formula CRR = 0.1 AL - 0.45 (r = .57; P < .05). Further analysis revealed that CRR, AL, and capillary density were all linearly related to the degree of hypertrophy.Conclusions-Decrements in CRR were related to changes of the coronary microcirculation. Both the decrease in CRR and these changes in the coronary microcirculation were related to the degree of hypertrophy. All these factors might contribute to the well-known occurrence of ischemia in this patient group.