Donor artery stenosis interactions with diastolic blood pressure on coronary collateral flow in type 2 diabetic patients with chronic total occlusion.
Donor artery stenosis interactions with diastolic blood pressure on coronary collateral flow in type 2 diabetic patients with chronic total occlusion.
复制标题
供体动脉狭窄与舒张压对慢性完全闭塞 2 型糖尿病患者冠状动脉侧支血流的相互作用
DOI：
10.1186/s12933-018-0724-x
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发表时间：
2018-06-01
影响因子：
9.3
通讯作者：
Shen WF
中科院分区：
文献类型：
--
作者：
Shen Y;Yang ZK;Hu J;Wang XQ;Dai Y;Zhang S;Zhang RY;Lu L;Ding FH;Shen WF
背景我们研究了在2型糖尿病慢性完全闭塞（CTO）患者中，主要侧支供血动脉（PCDA）狭窄是否以及在多大程度上影响与血压（BP）相关的冠状动脉侧支血流。接受经皮冠状动脉介入治疗CTO的糖尿病对照。结果糖尿病患者中、重度PCDA狭窄的CFI值均明显低于非糖尿病对照组，而糖尿病患者中、重度PCDA狭窄的CFI值均明显低于非糖尿病对照组（0.36 ± 0.10比0.45 ± 0.08，P < 0.001; 0.29 ± 0.09比0.35 ± 0.08，P = 0.008）。当PCDA轻度狭窄时，CFI随舒张压降低而沿着增加，舒张压低于60 mmHg时，CFI降低（0.38 ± 0.16 vs.0.57 ± 0.09，P < 0.001）。在存在中度PCDA狭窄的情况下，与非糖尿病对照组相比，糖尿病患者的CFI显著降低，舒张压70-79 mmHg时相对降低19.8%，60-69 mmHg时相对降低28.2%，60 mmHg以下相对降低38.2%（均P < 0.05）。一个严重的PCDA狭窄导致更明显的减少CFI，与相对减少37.3%的糖尿病患者相比，非糖尿病患者的舒张压低于60 mmHg（P = 0.050）。ConclusionsIn设置CTO，供体动脉狭窄时，舒张压降低冠状动脉侧支血流减少的风险更大。即使是PCDA的中度狭窄也可能与较低的侧支血流相关，因为2型糖尿病患者的舒张压低于80 mmHg。
BackgroundWe investigated whether and to what extent stenosis of predominant collateral donor artery (PCDA) affects coronary collateral flow in relation to blood pressure (BP) in type 2 diabetic patients with chronic total occlusion (CTO).MethodsCollateral flow index (CFI) as derived from intracoronary pressure distal to occluded segment and mean aortic pressure in 220 type 2 diabetic patients and 220 propensity score matched non-diabetic controls undergoing percutaneous coronary intervention for CTO. The severity of PCDA stenosis was graded according to lumen diameter narrowing.ResultsCFI decreased stepwise from mild to severe stenosis of the PCDA and was lower in diabetic patients with moderate or severe PCDA stenosis than in non-diabetic controls (0.36 ± 0.10 vs. 0.45 ± 0.08, P < 0.001; 0.29 ± 0.09 vs. 0.35 ± 0.08, P = 0.008). When the PCDA was mildly stenotic, CFI increased initially along with a reduction in diastolic BP, and decreased when diastolic BP was below 60 mmHg in diabetic patients (0.38 ± 0.16 vs. 0.57 ± 0.09, P < 0.001). In the presence of moderate PCDA stenosis, diabetic patients had significantly lower CFI compared to non-diabetic controls, with a relative reduction of 19.8% at diastolic BP 70–79 mmHg, 28.2% at 60–69 mmHg and 38.2% below 60 mmHg (all P < 0.05). A severe PCDA stenosis resulted in a more pronounced decrease in CFI, with a relative reduction of 37.3% for diabetics compared to non-diabetics when diastolic BP was below 60 mmHg (P = 0.050).ConclusionsIn the setting of CTO, donor artery stenosis confers greater risk for reduced coronary collateral flow when diastolic BP is decreased. Even a moderate stenosis in the PCDA may be associated with lower collateral flow as diastolic BP decreases below 80 mmHg in type 2 diabetic than in non-diabetic patients.
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影响因子：
37.8
作者：
De Bruyne, B;Hersbach, F;Wijns, W
通讯作者：
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影响因子：
39.3
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影响因子：
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DOI：
10.1161/circinterventions.114.002219
发表时间：
2015-04-01
影响因子：
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作者：
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影响因子：
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