LIMITATION IN PEAK CORONARY FLOW-VELOCITY IN MICROVASCULAR ANGINA

我们先前证实了心脏大静脉血流受限。 麦角新碱对快速心房起搏的反应 在没有心外膜冠状动脉疾病或痉挛的情况下， 我们现在称之为微血管性心绞痛。为了进一步研究 麦角新碱对冠脉血流储备的影响 冠脉内应用罂粟碱15 mg的基础血流速度，使用 可控多普勒导管在左前降支近端的应用 冠状动脉造影正常的5例心绞痛患者的动脉 冠状动脉。尽管初始峰-基流 对罂粟碱15毫克的速度反应正常(增减4.1 1.9，平均正负1S.D.)，麦角新碱后.15毫克 静脉注射后，峰值显著下降至基底部。 相同剂量罂粟碱(4.1plus或 减1.9至3.4加或减1.6，p小于0.05)和a 冠状动脉阻力指数显著增加(30.5以上 或负13.9至37.6加或减15.2，p小于0.05)。 术后左前降支近端内径 与罂粟碱治疗后相比，麦角新碱无明显变化。此外， 4例峰底血流速度降低的患者 麦角新碱治疗后有4例患者胸痛减轻。 麦角新碱后起搏时心脏静脉血流量的比较 到单独起搏，微血管心绞痛的主要标准。 因此，麦角新碱降低了峰值药物血流储备 微血管心绞痛患者，提示血管收缩 冠脉微循环。

We previously demonstrated limitation in great cardiac vein flow response to rapid atrial pacing following ergonovine administration in the absence of epicardial coronary artery disease or spasm, a syndrome we now call microvascular angina. To further study the effect of ergonovine on coronary flow reserve, we measured peak to basal flow velocity with papaverine 15 mg intracoronary, using a steerable Doppler catheter in the proximal left anterior descending artery in 5 patients with angina and angiographically normal coronary arteries. Although the initial peak to basal flow velocity response to papaverine 15 mg was normal (4.1 plus or minus 1.9, mean plus or minus 1 S.D.), after ergonovine .15 mg intravenously there was a significant fall in the peak to basal flow velocity response to the same dose of papaverine (4.1 plus or minus 1.9 to 3.4 plus or minus 1.6, p less than .05) and a significant increase in the coronary resistance index (30.5 plus or minus 13.9 to 37.6 plus or minus 15.2, p less than .05). Proximal left anterior descending artery dimensions after ergonovine did not change compared to after papaverine. Further, the 4 patients who had a decrease in peak to basal flow velocity after ergonovine were the same 4 who had chest pain and decreased great cardiac vein flow during pacing after ergonovine, compared to pacing alone, major criteria for microvascular angina. Thus, ergonovine decreases peak pharmacologic flow reserve in patients with microvascular angina, indicating vasoconstriction of the coronary microcirculation.