Comparison of adenosine to dipyridamole in degree of coronary hyperemic response in heart transplant recipients.
Comparison of adenosine to dipyridamole in degree of coronary hyperemic response in heart transplant recipients.
复制标题
腺苷与双嘧达莫在心脏移植受者冠状动脉充血反应程度方面的比较。
DOI：
10.1016/s0002-9149(96)00466-3
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发表时间：
1996
期刊：
影响因子：
--
通讯作者：
Botvinick,EH
中科院分区：
文献类型：
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作者：
Chou,TM;Sudhir,K;Amidon,TM;Klinski,CS;DeMarco,T;Chatterjee,K;Botvinick,EH
移植冠状动脉血管病变与内皮功能障碍有关。据报道，通过冠状动脉血流储备评估的微血管功能正常。我们使用冠状动脉内超声技术来同时评估血管扩张剂腺苷和双嘧达莫标准剂量的反应的电导和阻力血管功能。使用 0.014 英寸多普勒导丝上的 3.2Fr 或 4.3Fr、30 MHz 超声成像导管对 11 名心脏移植受者的冠状动脉血流动力学变化进行了评估，移植后平均持续时间为 784 ± 516 天。测量冠状动脉平均峰值流速（APV）和冠状动脉横截面积（CSA）用于计算静脉输注腺苷（4分钟内140μg/kg/min）和双嘧达莫（4分钟内140μg/kg/min）期间的体积流量。流量储备被评估为输注前最大药理学诱导流量与稳定基线流量的比率。 APV 增加（261.9% vs 194.6%，p = 0.005）、腔内 CSA（+11.8% vs +4.2%，p = 0.01）、峰值体积血流量（515.8 vs 317.2 ml/min，p = 0.007）和冠状动脉血流储备（2.93 ± 0.74 vs 1.99 ±）增加0.53，p <0.001）更高 腺苷优于双嘧达莫。两种药物均引起相似的全身血压下降，而心率几乎没有变化。在去神经人类移植受试者中，腺苷似乎是比双嘧达莫更有效的冠状血管扩张剂。腺苷在心外膜和微血管水平具有血管扩张作用，导致体积流量总体增加。与先前确定的值相比，响应两种内皮非依赖性药物的血流储备有所减少，但双嘧达莫的衰减更大。 (Am J Cardiol 1996;78:908–913)
Transplant coronary vasculopathy is associated with endothelial dysfunction. Microvascular function, assessed as coronary flow reserve, has been reported to be normal. We used intracoronary ultrasound technology to simultaneously assess conductance and resistance vessel function in response to standard dosages of the vasodilators adenosine and dipyridamole. Coronary hemodynamic changes were assessed in 11 heart transplant recipients, at a mean duration of 784 ± 516 days after transplantation, using a 3.2Fr or 4.3Fr, 30-MHz ultrasound imaging catheter over a 0.014-inch Doppler guidewire. Measures of coronary average peak flow velocity (APV) and coronary cross-sectional area (CSA) were used to calculate volumetric flow during intravenous infusions of adenosine (140 μg/kg/min over 4 minutes) and dipyridamole (140 μg/kg/min over 4 minutes). Flow reserve was assessed as a ratio of maximal pharmacologically induced flow to steady baseline flow before infusion. Increase in APV (261.9% vs 194.6%, p = 0.005), lumenal CSA (+11.8% vs +4.2%, p = 0.01), peak volumetric blood flow (515.8 vs 317.2 ml/min, p = 0.007), and coronary flow reserve (2.93 ± 0.74 vs 1.99 ± 0.53, p <0.001) were higher with adenosine than dipyridamole. Both agents caused similar decreases in systemic blood pressure and little change in heart rate. Adenosine appears to be a more potent coronary vasodilator than dipyridamole in denervated human transplant subjects. Adenosine has a vasodilator effect at the epicardial and microvascular levels, resulting in an overall increase in volumetric flow. Flow reserve in response to both endothelium-independent agents is decreased in comparison with previously established values, but the attenuation is greater with dipyridamole. (Am J Cardiol 1996;78:908–913)