BASIC STRUCTURE-FUNCTION RELATIONS OF THE EPICARDIAL CORONARY VASCULAR TREE - BASIS OF QUANTITATIVE CORONARY ARTERIOGRAPHY FOR DIFFUSE CORONARY-ARTERY DISEASE
BASIC STRUCTURE-FUNCTION RELATIONS OF THE EPICARDIAL CORONARY VASCULAR TREE - BASIS OF QUANTITATIVE CORONARY ARTERIOGRAPHY FOR DIFFUSE CORONARY-ARTERY DISEASE
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DOI：
10.1161/01.cir.85.6.1987
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发表时间：
1992-06-01
期刊：
影响因子：
37.8
通讯作者：
GOULD, L
中科院分区：
文献类型：
--
作者：
SEILER, C;KIRKEEIDE, RL;GOULD, L
背景资料。定量冠状动脉造影术已被证实可用于冠状动脉狭窄节段。然而，目前它不能解释弥漫性冠状动脉疾病，因为冠状动脉的正常大小对于其远端心肌床大小是未知的，并且不能在动脉弥漫性受累的情况下直接测量。本文根据12例非冠脉病变患者(第1组)和17例冠心病患者(第2组)的临床冠状动脉造影资料，用定量冠状动脉造影术测定了1)测量的冠状动脉横截面积、总的远端分支长度和每支冠状动脉各点远端局部心肌质量之间的关系，2)50个分叉处的冠脉管腔面积与母子血管面积的比值；3)三种不同的理论物理原理中的哪一种可以构成人类冠状动脉系统的树状结构，通过比较冠状动脉大小、分支长度、区域质量和父子腔面积比与不同理论物理原理的关系，来检验哪种原理最符合观察数据，因此哪种原理最有可能表征人类冠状动脉树结构。结果表明：1)无冠心病组和有冠心病组冠脉各点的管腔面积与相应的远端分支总长度和局部心肌质量密切相关，2)冠心病组的冠脉管腔面积较正常人明显偏小30%~50%，远端心肌床面积较正常人小30-50%。3)观察到的冠状动脉大小、远端总长度、心肌床大小和亲子比之间的关系不符合冠脉循环平均血流速度恒定的理论原理，而符合粘性能量损失最小和有限/自适应血管壁切应力的原理，其特征是冠脉管腔面积与远端总支长和局部质量或双子分支比呈2/3幂定律。这些观察结果为在临床动脉造影上量化弥漫性冠状动脉疾病提供了依据。
Background. Quantitative coronary arteriography has been validated for stenotic segments of coronary arteries. However, it does not currently account for diffuse coronary artery disease, because the normal size of the coronary artery for its distal myocardial bed size is not known and cannot be measured directly with diffuse involvement of the artery.Methods and Results. From clinical coronary arteriograms of 12 patients without coronary artery disease (group 1) and in 17 patients with coronary artery disease (group 2), we determined by quantitative coronary arteriography 1) the relations among measured coronary artery cross-sectional lumen area, summed distal branch lengths, and regional myocardial mass distal to each point in each coronary artery; 2) the ratio of coronary artery lumen area between parent and daughter vessels at 50 bifurcations; and 3) which of three different theoretical physical principles could underlie the tree structure of the human coronary artery system, by comparing the coronary artery size, branch lengths, regional mass, and relations between parent-to-daughter lumen area ratios with those for the different theoretical physical principles to test which principle best fit the observed data and therefore which principle most probably characterizes the human coronary artery tree structure. The results showed that 1) there is a close correlation between the lumen area of a coronary artery at each point along its length and the corresponding summed distal branch lengths and regional myocardial mass in patients without and with coronary artery disease; 2) measured coronary artery lumen area in patients with coronary artery disease is diffusely 30-50% too small for distal myocardial bed size compared with normal subjects; and 3) the observed relations among coronary artery size, distal summed lengths, myocardial bed size, and parent-to-daughter size ratios are not consistent with the theoretical principle of constant mean blood flow velocity in the coronary circulation but are consistent with the principles of minimum viscous energy loss and of limited/adaptive vascular wall shear stress characterized by a 2/3 power law relating coronary artery lumen area to distal summed branch lengths and regional mass or parent-to-daughter branching ratios.Conclusions. These observations provide a basis for quantifying diffuse coronary artery disease on clinical arteriograms.