alpha-Adrenergic receptors and coronary spasm: an elusive link.
alpha-Adrenergic receptors and coronary spasm: an elusive link.
复制标题
α-肾上腺素能受体和冠状动脉痉挛：难以捉摸的联系。
作者：
S. Chierchia;G. Davies;G. Berkenboom;F. Crea;P. Crean;A. Maseri;S. Chierchia
在连续14例变异性心绞痛患者中，我们研究了冠状动脉α -肾上腺素能受体在冠状动脉痉挛发生中的可能作用。在8例患者中，对连续霍尔特监测期间记录的心电图进行计算机化逐次分析，在197次冠状动脉痉挛引起的缺血发作前的一段时间内，没有发现任何心率增加和纠正的QT间期（心脏交感神经激活的两个指标）。在同一患者中，对缺血性发作的昼夜节律分布的分析显示，在交感神经活动处于最低水平的清晨，缺血性发作的发生率明显更高。12名患者接受了冷压、苯肾上腺素或去甲肾上腺素输注和马来酸麦角碱的连续刺激试验。麦角碱在所有12例患者中均引起冠状动脉痉挛，而冷压试验结果仅在1例患者中呈阳性。8例患者经β -阻断后输注苯肾上腺素或去甲肾上腺素均未引起心肌缺血。在5例患者中，与安慰剂相比，以最高耐受剂量输注酚妥拉明并没有显著减少缺血发作的次数。与以往报道的结果相反，我们的数据似乎排除了交感神经流向心脏的增加在冠状动脉痉挛的发生中起重要作用的假设。然而，我们不能排除心外膜动脉局部α刺激的可能性。
In 14 consecutive patients with variant angina we investigated the possible role of coronary alpha-adrenergic receptors in the genesis of coronary spasm. In eight patients, computerized, beat-by-beat analysis of the electrocardiogram recorded during continuous Holter monitoring failed to reveal any increase of heart rate and corrected QT interval (both indexes of cardiac sympathetic activation) in the period preceding the onset of ST segment changes in 197 episodes of ischemia caused by coronary spasm. In the same patients, analysis of the circadian distribution of ischemic episodes revealed a significantly higher incidence in the early morning hours, when sympathetic activity is at the lowest level. Twelve patients underwent serial provocative testing with cold pressor, phenylephrine, or norepinephrine infusion and administration of ergonovine maleate. Ergonovine consistently reproduced coronary spasm in all 12 patients, while results of cold pressor testing were positive in only one. Infusion of phenylephrine (eight patients) or norepinephrine after beta-blockade (four patients) failed to precipitate myocardial ischemia. In five patients infusion of phentolamine at the highest tolerated dose did not reduce significantly the number of ischemic attacks when compared with placebo. In contrast to results of previous reports, our data seem to rule out the hypothesis that an increase of sympathetic outflow to the heart plays an important role in the genesis of coronary spasm. We cannot, however, exclude the possibility of localized alpha-stimulation of epicardial arteries.
自发性冠状动脉痉挛过程中的动脉和冠状窦儿茶酚胺。
影响因子：
4.8
作者：
Robertson,RM;Bernard,Y;Robertson,D
通讯作者：
Robertson,D