Abnormal coronary reserve and left ventricular wall motion during cold pressor test in patients with previous left ventricular ballooning syndrome
Abnormal coronary reserve and left ventricular wall motion during cold pressor test in patients with previous left ventricular ballooning syndrome
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DOI：
10.1093/eurheartj/ehp325
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发表时间：
2009-12-01
影响因子：
39.3
通讯作者：
Gensini, Gian Franco
中科院分区：
文献类型：
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作者：
Barletta, Giuseppe;Del Pace, Stefano;Gensini, Gian Franco
目的探讨冷压试验（CPT）是否及如何影响既往左室球囊综合征（LVBS）患者的心肌灌注和左室功能。对17名既往LVBS患者和7名胸痛和冠状动脉正常的年龄和危险因素匹配的女性进行冷压试验（手浸入冰水中3分钟）。在CPT基线和峰值时，分别通过实时三维超声心动图（RT3DE）和心肌对比（SonoVue、Bracco）二维超声心动图（MCE） （Philips iE33机、X3-1和S5-1探头）定量评估整体和局部左室功能和心肌灌注。数据采用QLab 6.0软件离线分析。采用电化学高效液相色谱法测定外周静脉儿茶酚胺含量。冷压试验引起的血流动力学变化和儿茶酚胺升高与对照组和左室综合征患者相似。只有LVBS患者出现左心室射血分数下降，短暂性新中心室和心尖运动异常（定量RT3D分析），没有相应的灌注缺陷（MCE）。在CPT峰值，只有对照组的冠状动脉血流量和流速增加（定量MCE分析）。冷压试验仅在LVBS患者中引起左室壁运动异常，这与局部冠状动脉血流减少是不可比拟的。CPT后冠状动脉储备减少提示LVBS患者微血管功能障碍。
To investigate whether and how cold pressor test (CPT) could affect myocardial perfusion and left ventricular (LV) function in patients with previous LV ballooning syndrome (LVBS).Cold pressor test (3 min hand immersion in ice-water) was performed in 17 women with previous LVBS and in 7 age- and risk factor-matched women with chest pain and normal coronary arteries. At baseline and peak CPT, global and regional LV function, and myocardial perfusion were quantitatively assessed by real-time three-dimensional echocardiography (RT3DE) and myocardial contrast (SonoVue, Bracco) 2D echocardiography (MCE), respectively (Philips iE33 machine, X3-1 and S5-1 probes). Data were analysed off-line (QLab 6.0 software). Peripheral venous catecholamines were assayed by high performance liquid chromatography with electrochemical detection. Cold pressor test induced similar haemodynamic changes and catecholamine increase in controls and LVBS patients. Left ventricular ejection fraction decreased and transient new mid-ventricular and apical motion abnormalities developed in LVBS patients only (quantitative RT3D analysis), without corresponding perfusion defects (MCE). At peak CPT, coronary blood flow and velocity increased (quantitative MCE analysis) in control subjects only.Cold pressor test induced LV wall motion abnormalities unmatched to regional coronary flow reduction in LVBS patients only. The reduced coronary reserve in response to CPT suggests microvascular dysfunction in LVBS patients.