Coronary perivascular fibrosis is associated with impairment of coronary blood flow in patients with non-ischemic heart failure
Coronary perivascular fibrosis is associated with impairment of coronary blood flow in patients with non-ischemic heart failure
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DOI：
10.1016/j.jjcc.2012.06.009
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发表时间：
2012-11-01
影响因子：
2.5
通讯作者：
Shimokawa, Hiroaki
中科院分区：
文献类型：
--
作者：
Dai, Zhehao;Fukumoto, Yoshihiro;Shimokawa, Hiroaki
背景：虽然心肌间质纤维化被认为是慢性心力衰竭(HF)的致病因素，但血管周围纤维化(另一种纤维化形式)的作用尚不清楚。方法：2001年1月至2009年4月，东北大学附属医院收治的肥厚型心肌病(HCM，n=16)、高血压性心脏病(HHD，n=11)或扩张型心肌病(DCM，n=37)引起的非缺血性心衰患者，均经心导管检查和心内膜心肌活检(右室间隔)确诊。计算活检标本的胶原体积分数(CVF)和血管周围纤维化比率(PFR)，并检测心肌梗死(TIMI)中的溶栓情况以评价冠脉血流。结果：CVF和PFR之间无显著相关性(r(2)=0.0007)。尽管CVF在肥厚型心肌病中具有可比性。HHD、DCM分别为1.11+/-1.04、1.89+/-1.61、1.41+/-1.48，HCM组PFR显著高于DCM组(1.78+/-1.09比1.23+/-0.44，p<；0.05)。PFR与左心室射血分数、心输出量、左心室舒张末压、左心室舒张末容量、主动脉压或肺动脉压等心功能参数无关。然而，PFR与左前降支冠脉流量(TIMI帧计数)显著相关(r(2)=0.3351，p<；0.0001)，而与左回旋支或右冠状动脉无相关性。在7个变量(体重指数、PVR、CVF、高血压、血脂异常、糖尿病和心房颤动)的Logistic回归模型中，这种相关性仍然显著。结论：这些结果表明，冠状动脉血管周围纤维化与冠状动脉血流受损有关，但与间质纤维化或心功能无关，提示它可能成为改善冠状动脉微循环的新的治疗靶点。(C)2012年日本心脏病学院。爱思唯尔有限公司出版。保留所有权利。
Background: Although myocardial interstitial fibrosis has been considered to play a pathogenic role in chronic heart failure (HF), the role of perivascular fibrosis, another form of fibrosis, remains to be elucidated.Methods: We examined 64 consecutive patients with non-ischemic HF caused by hypertrophic cardiomyopathy (HCM, n = 16), hypertensive heart disease (HHD, n = 11), or dilated cardiomyopathy (DCM, n = 37), diagnosed by both cardiac catheterization and endomyocardial biopsy (right ventricular side of the interventricular septum) in the Tohoku University Hospital between January 2001 and April 2009. We calculated the collagen volume fraction (CVF) and perivascular fibrosis ratio (PFR) in biopsy samples and also examined Thrombolysis in Myocardial Infarction (TIMI) frame count to evaluate coronary blood flow.Results: There was no significant correlation between CVF and PFR (r(2) = 0.0007). Although CVF was comparable among HCM. HHD, and DCM (1.11 +/- 1.04, 1.89 +/- 1.61, and 1.41 +/- 1.48, respectively), PFR was significantly higher in HCM than in DCM (1.78 +/- 1.09 vs. 1.23 +/- 0.44, p < 0.05). PFR was not correlated with cardiac function parameters, such as left ventricular (LV) ejection fraction, cardiac output, LV end-diastolic pressure, LV end-diastolic volume, aortic pressure, or pulmonary artery pressure. However, PFR was significantly correlated with coronary flow in the left anterior descending coronary artery (as evaluated by TIMI frame count) (r(2) = 0.3351, p < 0.0001, in all-cases combined population), but not with that in the left circumflex or right coronary artery. This correlation remained significant in a logistic regression model tested in 7 variables (body mass index, PVR, CVF, presence of hypertension, dyslipidemia, diabetes mellitus, and atrial fibrillation).Conclusions: These results indicate that coronary perivascular fibrosis is associated with the impairment of coronary blood flow although not associated with interstitial fibrosis or cardiac function, suggesting that it can be a new therapeutic target to improve coronary microcirculation. (C) 2012 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.