CORONARY FLOW RESERVE ARE AFTER DIPYRIDAMOLE

我们和其他人已经证明了冠状动脉血流储备的局限性 冠状动脉微循环是心绞痛的常见发病机制 冠状动脉造影术显示心外膜冠状动脉正常的患者。我们 已经发现，这种有限的流量储备可以在快速 心房起搏，尤其是在给麦角新碱后，与 心绞痛与心肌梗塞的代谢和血液动力学证据 缺血症。因为起搏不能评估整个跨室壁 冠状动脉血流储备--一种强有力的冠状动脉血管扩张剂 (双嘧达莫)用于研究患者的峰值血流储备 尽管心外膜冠状动脉正常，但仍伴有心绞痛。二十 患者被确认为血管扩张剂储备异常。 起搏后典型胸痛缓解的基础 麦角新碱给药。与11名没有胸痛的患者相比， 这20名患者冠状动脉血流量显著降低，而冠状动脉血流量显著升高。 计算麦角新碱后起搏时冠脉阻力。之后 服用潘生丁后，同样20名患者出现的次数明显减少 与心绞痛患者相比，冠状动脉跨壁血流量增加 基于麦角新碱后起搏研究的正常血流储备。 此外，20名患者中有13名在 双嘧达莫，尽管流量不断增加。只有一名对照患者 经历过胸痛。因此冠脉血流储备受损的患者 对增加的心肌氧需求的反应也有限制 血流储备对潘生丁的反应，提示最大 血管舒张剂储备减少。这与 冠脉血流远离冠脉心肌的再分布 心内膜至心外膜，因小动脉前动脉变窄 冠状动脉。

We and others have demonstrated limitation in coronary flow reserve of the coronary micro-circulation to be a frequent mechanism of angina pectoris in patients with angiographically normal epicardial coronary arteries. We have found that this limited flow reserve can be demonstrated during rapid atrial pacing, especially after ergonovine administration, associated with angina pectoris and metabolic and hemodsynamic evidence of myocardial ischemia. Because pacing does not allow assessment of total transmural coronary flow reserve, a potent coronary arterial vasodilator (dipyridamole) was utilized to investigate peak flow reserve in patients with anginal pain despite normal epicardial coronary arteries. Twenty patients were identified as having abnormal vasodilator reserve on the basis of precipitation of typical chest pain after pacing following the administration of ergonovine. Compared to 11 patients without chest pain, these 20 patients had significantly lower coronary blood flow and higher calculated coronary resistance during pacing after ergonovine. After administration of dipyridamole, the same 20 patients had significantly less of an increase in transmural coronary flow compared to the patients with normal flow reserve based on the pacing study after ergonovine. Additionally, 13 of the 20 patients experienced severe chest pain during dipyridamole despite an increse in flow. Only one control patient experienced chest pain. Thus patients with impaired coronary flow reserve in response to increasing myocardial oxygen demands also have limitation of flow reserve in response to dipyridamole, suggesting that maximal vasodialtor reserve is reduced. This is compatible with the concept of a coronary myocardial redistribution of coronary flow away from the endocardium to the epicardium because of narrowing of small prearteriolar coronary arteries.