IMPAIRMENT OF CORONARY VASCULAR RESERVE AND ACH-INDUCED CORONARY VASODILATION IN DIABETIC-PATIENTS WITH ANGIOGRAPHICALLY NORMAL CORONARY-ARTERIES AND NORMAL LEFT-VENTRICULAR SYSTOLIC FUNCTION
IMPAIRMENT OF CORONARY VASCULAR RESERVE AND ACH-INDUCED CORONARY VASODILATION IN DIABETIC-PATIENTS WITH ANGIOGRAPHICALLY NORMAL CORONARY-ARTERIES AND NORMAL LEFT-VENTRICULAR SYSTOLIC FUNCTION
复制标题
DOI：
10.2337/diabetes.42.7.1017
复制
发表时间：
1993-07-01
期刊：
影响因子：
7.7
通讯作者：
ATTALI, JR
中科院分区：
文献类型：
--
作者：
NITENBERG, A;VALENSI, P;ATTALI, JR
越来越多的证据表明糖尿病患者存在小血管病变和内皮依赖性血管扩张障碍。这项研究的ALM是比较11名糖尿病患者(6名I型和5名II型)和7名对照组的冠脉循环。所有患者左心室收缩功能正常，冠状动脉造影正常。为了评估冠状动脉微循环的最大面积，通过冠状动脉内多普勒和最大血管扩张剂量罂粟碱(峰/静息冠脉血流速度比)来确定冠脉储备。为评价冠状动脉内分步输注乙酰胆碱(10(-8)~10(-5)M)的血管内皮功能，应用定量血管造影术分析了每例患者4个不同节段的血管内皮功能反应。糖尿病患者冠脉峰/静息血流速度比低于对照组(分别为3.9+/-0.9和5.0+/-0.7，P<0.02)。乙酰胆碱在10(-8)和10(-7)M处直径变化不大，但在10(-6)和10(-5)M处出现渐进性直径缩小(分别为-8.0±15.2%，P<；0.02和-24.0+/-13.6%，P<；0.001)。对照组的血管直径从10(-8)M逐渐增大到10(-6)M(P&0.001)，分别为5.1M+/-3.4M、12.1+/-7.0M和16.4M+/-7.3%。在两组中，冠脉内注射硝酸异山梨酯后，所有节段扩张相似。总之，这些结果提供了证据，糖尿病可能是冠状动脉造影术正常的患者冠状动脉循环结构和功能改变的原因。糖尿病患者冠脉循环的这些改变可能导致心肌的进行性恶化，从而导致糖尿病心肌病的发生。
Evidence is increasing for small-vessel disease and disturbance of endothelium-dependent vasodilation in diabetic patients. The alm of this study was to compare coronary circulation in 11 diabetic patients (6 type I and 5 type II) and 7 control subjects. All patients had normal left ventricular systolic function and angiographically normal coronary arteries. To evaluate the maximal area of coronary microcirculation, coronary vascular reserve was determined by intracoronary Doppler and a maximally vasodilating dose of intracoronary papaverine (peak-to-resting coronary flow velocity ratio). To assess coronary endothelial function responses to stepwise intracoronary infusion of acetylcholine (10(-8) to 10(-5) M coronary estimated concentrations) were analyzed on four different segments in each patient by quantitative angiography. Peak-to-resting coronary flow velocity ratio was lower in diabetic patients than in control subjects (3.9 +/- 0.9 and 5.0 +/- 0.7, respectively, P < 0.02). Acetylcholine did not produce any diameter change at 10(-8) and 10(-7) M , but a progressive diameter reduction was observed at 10(-6) and 10(-5) M (-8.0 +/- 15.2%, P < 0.02 and -24.0 +/- 13.6%, P < 0.001, respectively). In control subjects, a progressive diameter dilation was produced from 10(-8) to 10(-6) M acetylcholine (5.1 +/- 3.4,12.1 +/- 7.0, and 16.4 +/- 7.3%, respectively, all P < 0.001), and a moderate reduction was observed at 10(-5) M (-4.9 +/- 7.5%, P < 0.02). In the two groups, all segments dilated similarly after intracoronary isosorbide dinitrate. In conclusion, these results provide evidence that diabetes mellitus may be responsible for both structural and functional alterations of the coronary circulation in patients with angiographically normal coronary arteries. These alterations of the coronary circulation in diabetic patients may contribute to the progressive deterioration of the myocardium and to the pathogenesis of diabetic cardiomyopathy.