CORONARY FLOW RESERVE AND ABNORMAL LEFT VENTRICULAR RESPONSE TO EXERCISE

有胸痛和冠状动脉造影正常的患者中有一部分是 据信患有冠状动脉微血管功能障碍限制了 冠脉血流储备。为了评估药理学是否 冠状动脉血流储备的测量与左冠状动脉的反应相关 我们测量了左主干的冠脉血流速度 27例冠状动脉正常的胸痛患者的冠状动脉 静息状态下的血管造影和正常的左心功能。涨幅 腺苷后冠脉血流速度超过基线，一种有效的 10例左冠状动脉异常患者的冠状动脉微血管扩张剂 放射性核素血管造影术对运动的心室反应为 与17例左心室正常的患者不同 对运动的反应。然而，重复评估冠脉流量 静脉注射麦角新碱15毫克后的储备显示 10例冠心病患者对腺苷的冠脉血流速度反应 运动中左心室异常反应与无变化的对比 17例运动后左心功能正常的患者。 因此，冠脉血流储备的药理学评估前和 跟随麦角新暗示的是动态的而不是固定的异常 冠状动脉微血管功能与左冠状动脉异常相关 胸痛患者运动后的心室反应 冠状动脉造影正常。

A subset of patients with chest pain and normal coronary angiograms are believed to have coronary microvascular dysfunction which limits coronary flow reserve. In order to assess whether pharmacologic measures of coronary flow reserve correlate with responses of the left ventricle to stress, we measured coronary flow velocity in the left main coronary artery of 27 patients with chest pain and normal coronary angiograms and normal left ventricular function at rest. The increase in coronary flow velocity over baseline following adenosine, a potent coronary microvascular vasodilator in 10 patients with abnormal left ventricular responses to exercise by radionuclide angiography was no different from that of 17 patients with normal left ventricular responses to exercise. However, repeat assessment of coronary flow reserve following ergonovine .15 mg intravenously showed a decline in coronary flow velocity response to adenosine in the 10 patients with abnormal left ventricular responses to exercise in contrast to no change in the 17 patients with normal left ventricular responses to exercise. Thus, pharmacologic assessment of coronary flow reserve before and following ergonovine suggests dynamic rather than fixed abnormality of coronary microvascular function is associated with abnormal left ventricular responses to exercise in patients with chest pain despite normal coronary angiograms.