ANGINA DUE TO CORONARY MICROVASCULAR DISEASE IN HYPERTENSIVE PATIENTS WITHOUT LEFT-VENTRICULAR HYPERTROPHY
ANGINA DUE TO CORONARY MICROVASCULAR DISEASE IN HYPERTENSIVE PATIENTS WITHOUT LEFT-VENTRICULAR HYPERTROPHY
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DOI：
10.1056/nejm198811173192002
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发表时间：
1988-11-17
影响因子：
158.5
通讯作者：
EPSTEIN, SE
中科院分区：
文献类型：
--
作者：
BRUSH, JE;CANNON, RO;EPSTEIN, SE
当高血压患者发生心绞痛时，通常被归因于冠状动脉疾病或左室肥厚。为了确定冠状动脉微血管异常在高血压患者心绞痛中的作用，我们通过测量应用麦角新前后快速心房起搏的冠脉反应来评估无冠状动脉疾病或左室肥厚的高血压患者。我们比较了12例有起搏诱发心绞痛的高血压患者和13例血压正常的无此心绞痛的患者。两组患者静息时的冠脉流量(心脏大静脉)相似；然而，在高血压心绞痛患者中，起搏增加的冠脉流量比正常血压受试者少(48%比83%；P=0.05)。在高血压心绞痛患者中，麦角新碱起搏后冠脉流量仅增加32%(与麦角新素前的48%相比P<；0.05)，冠脉阻力降低15%(与麦角新素前的28%相比)，表明存在麦角新碱引起的血管收缩。相比之下，在血压正常的受试者中，麦角新碱后的心脏起搏使冠脉流量增加了112%(P<；0.001)，其对冠状动脉阻力的影响与麦角新碱前的起搏没有区别。高血压心绞痛患者在麦角新碱治疗后起搏时心肌氧摄取量显著增加，心肌乳酸消耗增加较少。这一反应与心肌缺血的存在相一致。因此，无心外膜冠状动脉病变的高血压患者的心绞痛可能是由心肌缺血引起的，这似乎是由于冠状动脉微血管阻力异常升高所致。
When angina occurs in patients with hypertension, it is usually attributed to coronary artery disease or left ventricular hypertrophy. To determine the contribution of coronary microvascular abnormalities to angina in patients with hypertension, we evaluated hypertensive patients without coronary artery disease or left ventricular hypertrophy by measuring the coronary response to rapid atrial pacing before and after administration of ergonovine. We compared 12 hypertensive patients who had pacing-induced angina with 13 normotensive subjects without such angina. The two groups had similar coronary flow (in the great cardiac vein) at rest; however, pacing increased coronary flow less in hypertensive patients with angina than in normotensive subjects (48 vs. 83 percent; P = 0.05). In the hypertensive patients with angina, pacing after ergonovine increased coronary flow by only 32 percent (as compared with 48 percent before ergonovine; P < 0.05) and decreased coronary resistance by 15 percent (as compared with 28 percent before ergonovine; P < 0.05), indicating the presence of ergonovine induced vasoconstriction. In nomotensive subjects, in contrast, cardiac pacing after ergonovine increased coronary flow by 112 percent (P < 0.001), and its effect on coronary resistance was not different from that of pacing before ergonovine. The hypertensive patients with angina had a significant increase in myocardial oxygen extraction during pacing after ergonovine and less of an increase in myocardial lactate consumption.sbd.a response consistent with the presence of myocardial ischemia. Thus, angina in hypertensive patients without epicardial coronary disease may be caused by myocardial ischemia, which appears to be due to an abnormally elevated resistance of the coronary microvasculature.