Abnormal myocardial phosphorus-31 nuclear magnetic resonance spectroscopy in women with chest pain but normal coronary angiograms
Abnormal myocardial phosphorus-31 nuclear magnetic resonance spectroscopy in women with chest pain but normal coronary angiograms
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DOI：
10.1056/nejm200003233421201
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发表时间：
2000-03-23
影响因子：
158.5
通讯作者：
Pohost, GM
中科院分区：
文献类型：
--
作者：
Buchthal, SD;den Hollander, JA;Pohost, GM
背景：女性因胸痛住院后，冠状动脉造影正常的可能性高于男性。在这些妇女中，在没有临床上显著的冠状动脉阻塞的情况下，心肌缺血一直被怀疑。大多数检测心肌缺血代谢效应的方法都是高度侵入性的。磷-31核磁共振（P-31-NMR）光谱是一种非侵入性的技术，可以直接测量高能量磷酸盐在心肌和识别代谢证据ischemia.Methods：我们招募了35名妇女住院胸痛，但谁没有血管造影显着的冠状动脉阻塞和12个年龄和体重匹配的对照妇女没有心脏病的证据。在等长握柄运动之前、期间和之后（水平为最大随意握力的30%），使用P-31-NMR光谱法在1.5特斯拉下测量心肌高能磷酸盐。我们测量了运动过程中磷酸肌酸ATP的比例的变化。结果：七（20%）的35名女性胸痛，没有血管造影显着狭窄下降的磷酸肌酸：ATP的比例在握力超过2 SD低于平均值在对照组无胸痛。两组之间在静息时和握柄时的血流动力学变量、缺血性心脏病的危险因素、心脏磁共振成像和放射性核素灌注研究的结果或乙酰胆碱输注期间肱动脉血流的变化方面没有显著差异。我们的研究结果提供了直接的证据，至少在一些胸痛的妇女中，对握力运动的异常代谢反应与心肌缺血的发生一致，但没有血管造影显著冠状动脉狭窄。（N Engl J Med 2000;342：829-35.）（C）2000年，马萨诸塞州医学会。
Background: After hospitalization for chest pain, women are more likely than men to have normal coronary angiograms. In such women, myocardial ischemia in the absence of clinically significant coronary-artery obstruction has long been suspected. Most methods for the detection of the metabolic effects of myocardial ischemia are highly invasive. Phosphorus-31 nuclear magnetic resonance (P-31-NMR) spectroscopy is a noninvasive technique that can directly measure high-energy phosphates in the myocardium and identify metabolic evidence of ischemia.Methods: We enrolled 35 women who were hospitalized for chest pain but who had no angiographically significant coronary-artery obstructions and 12 age- and weight-matched control women with no evidence of heart disease. Myocardial high-energy phosphates were measured with P-31-NMR spectroscopy at 1.5 tesla before, during, and after isometric handgrip exercise at a level that was 30 percent of the maximal voluntary grip strength. We measured the change in the ratio of phosphocreatine to ATP during exercise.Results: Seven (20 percent) of the 35 women with chest pain and no angiographically significant stenosis had decreases in the phosphocreatine:ATP ratio during handgrip that were more than 2 SD below the mean value in the control subjects without chest pain. There were no significant differences between the two groups with respect to hemodynamic variables at rest and during handgrip, risk factors for ischemic heart disease, findings on magnetic resonance imaging and radionuclide perfusion studies of the heart, or changes in brachial flow during the infusion of acetylcholine.Conclusions: Our results provide direct evidence of an abnormal metabolic response to handgrip exercise in at least some women with chest pain consistent with the occurrence of myocardial ischemia but no angiographically significant coronary stenoses. (N Engl J Med 2000;342:829-35.) (C)2000, Massachusetts Medical Society.