Comparison of three methods of evaluating coronary obstructive lesions: postmortem arteriography, pathologic examination and measurement of regional myocardium perfusion during maximal vasodilation.
Comparison of three methods of evaluating coronary obstructive lesions: postmortem arteriography, pathologic examination and measurement of regional myocardium perfusion during maximal vasodilation.
复制标题
评估冠状动脉阻塞性病变的三种方法的比较：死后动脉造影、病理检查和最大血管舒张期间局部心肌灌注测量。
DOI：
10.1016/0002-9149(82)90248-x
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发表时间：
1982
影响因子：
2.8
通讯作者：
A. Mark
中科院分区：
文献类型：
--
作者：
M. Marcus;M. Armstrong;D. Heistad;C. Eastham;A. Mark
通过血管造影和病理技术对患者进行的大量冠状动脉阻塞性病变研究得出结论，血管造影术严重低估了阻塞的严重程度。一般认为，冠状动脉未扩张血管的形态学检查是一个合理的参考标准。为了验证这一假设，在饮食诱导的冠状动脉粥样硬化食蟹猴中比较了三种检查冠状动脉的方法。在最大冠状动脉血管舒张期间测量总和局部心肌灌注，在全身压力下注射造影剂进行死后冠状动脉造影，并病理性延长未扩张的冠状动脉血管。在这些动脉粥样硬化猴中，心外膜动脉存在广泛的内膜变化，从脂肪条纹到大斑块伴中膜萎缩;形态学研究显示平均（±平均值的标准误差）管腔狭窄为57 ± 3%（范围38 - 76）。死后冠状动脉造影显示没有局部阻塞的证据。在静息状态下，整体和透壁左心室灌注正常。在最大冠状动脉舒张期，动脉粥样硬化猴的最小冠状动脉血管阻力高于正常对照猴（0.21 ± 0.04 vs 0.13 ± 0.07 mm Hg/ml × ml/min × 100 g）（p <0.07）。没有证据表明，在任何一组猴子在控制条件下或在最大冠状动脉vasodilation.The通畅的冠状动脉造影结果和只有适度的损害灌注，尽管中度阻塞性病变，局部灌注不足，表明在正常的扩张压力冠状动脉粥样硬化病变向外移位，内侧萎缩可能允许扩张和保存的管腔大小。因此，在食蟹猴饮食诱导的冠状动脉粥样硬化，病理检查的非扩张冠状动脉血管似乎高估了血流动力学意义的病变。这些实验结果与评价患者冠状动脉粥样硬化病变的相关性仍有待确定。
Numerous studies of coronary obstructive lesions in patients by angiographic and pathologic techniques have concluded that the severity of obstruction is seriously underestimated by angiography. It has generally been assumed that morphologic examination of an undistended coronary vessel is a reasonable reference standard. To test this assumption, three methods of examining coronary arteries were compared in cynomolgus monkeys with diet-induced coronary atherosclerosis. Total and regional myocardial perfusion during maximal coronary vasodilation were measured, postmortem coronary arteriography was performed with contrast medium injected at systemic pressure and the undistended coronary vessels were extended pathologically. In these atherosclerotic monkeys, there were widespread intimai changes in the epicardial arteries ranging from fatty streaks to large plaques with medial atrophy; morphometric studies showed a mean (± standard error of the mean) luminal stenosis of 57 ± 3 percent (range 38 to 76). Postmortem coronary arteriograms showed no evidence of localized obstruction. Under resting conditions, global and transmural left ventricular perfusion were normal. During maximal coronary vasodilation, minimal coronary vascular resistance was higher (p <0.07) in these monkeys with atherosclerosis than in normal control monkeys (0.21 ± 0.04 versus 0.13 ± 0.07 mm Hg/ml × ml/min × 100 g). No evidence of localized perfusion deficits was observed in either group of monkeys under control conditions or during maximal coronary vasodilation.The findings of unobstructed coronary angiograms and only modest impairment of perfusion, despite moderate obstructive lesions, suggest that at normal distending pressures coronary atherosclerotic lesions are outwardly displaced; medial atrophy may allow dilation and preservation of luminal size. Thus, in cynomolgus monkeys with diet-induced coronary atherosclerosis, pathologic examination of the undistended coronary vessel appears to overestimate the hemodynamic significance of the lesions. The relevance of these experimental findings to the evaluation of atherosclerotic coronary lesions in patients remains to be determined.