The Research on the Lowering of Coronary Flow Reserve and Smooth Muscle Transformation of Small Coronary Artery in Hypertrophic Cardiomyopathy.

A）冠状动脉血流储备和内皮依赖性扩张反应：与正常对照组（C）相比，使用罂粟碱的肥厚型心肌病（HCM）组的冠状动脉血流储备明显降低。(1.8±0.4和2.9±0.5; p<0.001）。HCM组的血管内皮依赖性舒张反应较C组明显降低，超过了冠状动脉储备能力（1.2±0.2，2.5±0.4; p<0.001）.B）心肌内小动脉的病理学评价：内膜明显增生，HCM组心肌活检获得壁内小冠状动脉中膜复合体（%LA=22.4±15.2%）。HCM组冠状动脉小血管周围纤维环增生明显（PFR=5.3±3.1）。尽管冠状动脉血流储备与%LA呈线性相关，与PFR呈负相关，但无论如何， ...更多信息 也有很大的相关性。而且，尽管最大%APV和PFR也倾向于与Increase相关，但这也不显著。%LA与最大%APV呈显著正相关。高频心房起搏时冠状动脉血流量增加的百分比随着冠状动脉壁内-中膜复合体的增厚而降低。C）冠状动脉壁内平滑肌的转化用单克隆抗体进行免疫组化染色，观察冠状动脉壁内-中膜复合体中平滑肌转化的存在。内膜-中膜复合体常被纤维组织覆盖，而平滑肌细胞常减少。免疫组化染色结果显示，只有少数病例染色清晰，不能清楚地证明平滑肌的转化。部分病例小冠状动脉内膜-中层复合体中存在以未分化非肌球蛋白（SM emb）为主的转化。少

A) Coronary flow reserve and endothelium-dependent dilator response.The coronary flow reserve, using the papaverine, in the hypertrophic cardiomyopathy (HCM) group lowered clearly in comparison with that of the normal control ( C ) group. (1.8±0.4 and 2.9±0.5, respectively ; p<0.001). The endothelium-dependent dilator response required in the acetylcholine administration was more remarkable loweing over the coronary reserve capacity in the HCM group than that of C group (1.2±0.2, 2.5±0.4, respectively ; p<0.001).B) Pathologic evaluation of the small artery in heart muscle.There was the clear hyperplasia in intima-media complex of intramural small coronary arteries got from myocardial biopasy in the HCM group(%LA=22.4±15.2%). Moreover, there was the remarkable hyperplasy on the circuferencial fibrosis around the small coronary vessel in the HCM group (PFR=5.3±3.1). Though the coronary flow reserve tended to correlate lineally with %LA, and inversely with PFR, anyway not obtained the sig … More nificant correlation either. And, though max %APV and PFR tended to also correlate Inversely, this was not also significant. There is significant positive correlation on %LA with max%APV. Percent increase of coronary blood flow in the high-frequent atrial pacing was more reduced, as the intima-media complex of intramural coronary artery was thicker.C) The transformation of the smooth muscle in intramural coronary artery.The immunostaining was carried out using the monoclonal antibody, and the existence of the transformation of the smooth muscle in the intima-media complex was examined. The Intima-media complex was often covered for the fibrous tissues, and rather the smooth muscle cell often decreased. There was few cases dyed clearly by the immunostaining, and it was not possible to prove the transformation of the smooth muscle clearly. However, is a part of case, there was the transformation mainly on undifferentiated non-muscle myosin(SM emb) in the intima-media complex of the small coronary artery. Less