Effect of endothelial dysfunction on regional perfusion in myocardial territories supplied by normal and diseased vessels in patients with coronary artery disease
Effect of endothelial dysfunction on regional perfusion in myocardial territories supplied by normal and diseased vessels in patients with coronary artery disease
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DOI：
10.1016/s1071-3581(00)70007-9
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发表时间：
2000-05-01
影响因子：
2.4
通讯作者：
DiCarli, MF
中科院分区：
文献类型：
--
作者：
Masoli, O;Baliño, NP;DiCarli, MF
冠状动脉张力的内皮依赖性调节同时影响管道和阻力冠状动脉。然而，心肌灌注显像在评价冠状动脉内皮功能方面的作用知之甚少。我们评估了冠状动脉内乙酰胆碱反应的冠状动脉血管运动的侵入性血管造影测量值与锝99 m sestamibi成像评估的区域灌注异常的存在之间的关系。我们研究了11例疑似冠状动脉疾病的患者（9例男性和2例女性）（48 ± 8岁，平均值±标准差）。我们使用定量冠状动脉造影术来描绘血管对冠状动脉内给予的增加剂量的乙酰胆碱的反应。在给予乙酰胆碱期间和之后，通过平面Tc-99 mSestamibi成像来评估局部心肌灌注。在11例患者中，分析了23个冠状动脉区域：13个血管造影正常，10个显示不同程度的管腔狭窄。13支血管造影正常的冠状动脉中有4支（31%）对乙酰胆碱有阳性血管扩张反应（管腔直径缩小≥ 20%），与局部灌注缺损相关。乙酰胆碱诱导了阳性血管扩张反应，这也与3支中度狭窄冠状动脉中的1支存在局部灌注缺损有关在7支狭窄的冠状动脉中，乙酰胆碱可诱导6支血管的阳性反应，（大于或等于70%），其中5例显示相应的区域灌注缺损。在冠状动脉疾病患者中，用Tc-99 m sestamibi无创性测量局部心肌灌注与有创性测量冠状动脉内皮功能相关性良好。这些发现可能对监测旨在改善冠状动脉疾病患者内皮功能和微血管功能的干预措施的效果有意义。
Background, Endothelium-dependent regulation of coronary tone affects both conduit and resistance coronary arteries. However, little is known about the usefulness of myocardial perfusion imaging in evaluating coronary endothelial function. We evaluated the relation between invasive angiographic measurements of coronary vasomotion in response to intracoronary acetylcholine and the presence of regional perfusion abnormalities assessed by technetium 99m sestamibi imaging.Methods and Results. We studied 11 patients (9 men and 2 women) with suspected coronary artery disease (48 +/- 8 years, mean +/- standard deviation). We used quantitative coronary angiography to delineate the vasomotor response to increasing doses of acetylcholine given intracoronary, Regional myocardial perfusion was assessed by planar Tc-99m sestamibi imaging during and after the administration of acetylcholine. In the 11 patients, 23 coronary artery territories were analyzed: 13 were angiographically normal, and 10 showed varying degrees of luminal narrowing. Four (31%) of 13 angiographically normal coronary arteries had a positive vasomotor response to acetylcholine (greater than or equal to 20% reduction in luminal diameter) that was associated with a regional perfusion defect. Acetylcholine induced a positive vasomotor response, which was also associated with a regional perfusion defect in 1 of 3 coronary arteries with stenoses of intermediate severity (50% to 69%), Likewise, acetylcholine induced a positive vasomotor response in 6 of 7 coronary arteries with significant luminal narrowing (greater than or equal to 70%), 5 of which showed a corresponding regional perfusion defect.Conclusions. In patients with coronary artery disease, noninvasive measurements of regional myocardial perfusion by Tc-99m sestamibi correlate well with invasive measurements of coronary endothelial function. These findings may have implications for monitoring the effects of interventions designed to improve endothelial function and microvascular function in patients with coronary artery disease.