Effects of selective α1- and α2-adrenergic blockade on coronary flow reserve after coronary stenting
Effects of selective α1- and α2-adrenergic blockade on coronary flow reserve after coronary stenting
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DOI：
10.1161/01.cir.0000040998.88272.a7
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发表时间：
2002-12-03
期刊：
影响因子：
37.8
通讯作者：
Heusch, G
中科院分区：
文献类型：
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作者：
Gregorini, L;Marco, J;Heusch, G
背景-冠状动脉血流储备（CFR）在冠状动脉支架植入术后短期内未恢复正常。我们假设，α-肾上腺素能冠状动脉血管收缩的行为，以限制CFR.Methods和Results-We评估血流速度多普勒导线和血管造影的横截面积在46例冠状动脉罪犯病变支架（81 +/-4%狭窄）。在支架植入前后，腺苷（24 μ g IC或140 μ g/kg/min IV）诱导充血。最后，α（1）-拮抗剂乌拉地尔（10 mg IC）或α（2）-拮抗剂育亨宾（3 mg IC）与腺苷随机联合。在8例冠状动脉造影正常的受试者中，育亨宾和乌拉地尔分别使CFR从3.21 +/-0.30增加到3.74 +/-0.43和4.58 +/-0.65（P = 0.0001）。根据CFR ≥ 3.0（n = 18）或<2.5（n = 28）的临界值对患者进行分组。血运重建本身未改变CFR。然而，支架植入后15分钟，CFR从CFR 3.64 +/-0.58降至2.05 +/-0.55，而CFR 2.39 +/-0.51的患者保持不变。育亨宾使基线CFR> 3.0和<2.05 +/-0.55的患者的CFR分别改善至3.26 +/-0.42和3.41 +/-0.58。乌拉地尔使CFR分别提高到3.52 ± 0.30和3.98 ± 1.07.Conclusion-Urapidil和育亨宾通过增加腺苷的心外膜血管舒张作用和血流速度来减轻血管重建后CFR的损害，从而表明肾上腺素能系统在限制冠状动脉循环扩张能力中起重要作用。
Background-Coronary flow reserve (CFR) is not normalized shortly after coronary stenting. We hypothesized that a-adrenergic coronary vasoconstriction acts to limit CFR.Methods and Results-We assessed flow velocity by Doppler wires and cross-sectional area by angiography in 46 patients undergoing coronary culprit lesion stenting (81 +/- 4% stenosis). Hyperemia was induced by adenosine (24 mug IC or 140 mug/kg per minute IV) before and after stenting. Finally, either the alpha(1)-antagonist urapidil (10 mg IC) or the alpha(2)-antagonist yohimbine (3 mg IC) was randomly combined with adenosine. In 8 subjects with angiographically normal coronary arteries, CFR was increased from 3.21 +/- 0.30 to 3.74 +/- 0.43 by yohimbine and to 4.58 +/- 0.65 by urapidil, respectively (P = 0.0001). Patients were divided according to the cutoff of CFR greater than or equal to 3.0 (n = 18) or < 2.5 (n = 28). Revascularization per se did not change CFR. However, 15 minutes after stenting, CFR decreased to 2.05 +/- 0.55 from CFR 3.64 +/- 0.58, whereas in patients with CFR 2.39 +/- 0.51, it remained unchanged. Yohimbine improved CFR to 3.26 +/- 0.42 and to 3.41 +/- 0.58 in patients with > 3.0 and < 2.05 +/- 0.55 baseline CFR, respectively. Urapidil improved CFR to 3.52 +/- 0.30 and 3.98 +/- 1.07, respectively.Conclusions-Urapidil and yohimbine attenuated the CFR impairment occur-ring after revascularization by increasing both the epicardial vasodilator effect of adenosine and the blood flow velocity, thus suggesting that the adrenergic system plays an important role in limiting the capacity of the coronary circulation to dilate.