左室肥厚对冠脉血流储备的影响

摘要

目的：用冠状动脉内多普勒血流速度描记的 方法评价左室肥厚对冠脉血流速度及血流储备的影响。方法：研究对象为41例冠脉造影正常的患者。分三组：甲组为11例无冠脉微 血管病变基础者，男9例，女2例，年龄(48.91±7.18)岁，共27支冠脉，包括前降支10支 ，回旋支6支，右冠脉10支，对角支1支。乙组为16例有冠脉微血管病变基础但无左室肥厚者 ，男9例，女7例，年龄(56.63±9.83)岁，共41支冠脉，包括前降支16支，回旋支11支， 右冠脉13支，对角支1支。丙组为14例左室肥厚者，男9例，女5例，年龄(60.14±8.98)岁 ，共28支冠脉，包括前降支9支，回旋支7支，右冠脉12支。用Cardiometrics Flomap Ⅱ仪 器和0.014英寸多普勒钢丝测量：远端平均峰速(APV)、舒张期与收缩期流速比(D/SVR)、血 流储备(CFR)和近端与远端流速比(P/DVR)。左室心肌重量用二维超声心动图法测定。结果：与甲组相比，丙组冠脉远端基础状态APV显著较高(P＝0.0023)， 而冠脉远端CFR显著较低(P＝0.031)。丙组冠脉远端CFR亦较无左室肥厚的乙组低(P ＝0.034)。同时左室心肌重量与左冠脉CFR呈负相关(r＝－0.36，P＜0.0 5)。乙组CFR虽较甲组低，但差别无显著意义(P＞0.05)。结论：左室肥厚引起基础APV升高，是造成冠脉血流储备降低的重要原因之一。%Objective:The purpose of this study was to evaluate the effect of left ventricular hypertrophy on coronary flow reserve(CFR ).Methods：Forty one angiographically normal patients were studied by using Cardiometrics Flomap Ⅱ Ultrasound Instrument and 0.014 inch f lowire.The patients were divided into three groups:group A,11 patients(27 arteri es)without underlying diseases of coronary microvasuclar lesions;group B,16 pati ents(41 arteries)with underlying diseases of coronary microvascular lesions but without left ventricular hypertrophy;group C,14 patients (28 arteries)with under lying diseases of coronary microvascular lesions and left ventriuclar hypertroph y.The flow velocity measurements included average peak velocity(APV),diastolic/ systolic velocity ratio(D/SVR),coromary flow reserve(CFR)and proximal/distal vel ocity ratio(P/DVR).Results:The distal baseline APV of group C was significantly h igher than that of group A(P＝0.0023).The distal CFR in group C was remarka bly lower than that of group A(P＝0.031) and group B(P＝0.034).CFR of left coronary arteries in all groups was inversely correlated with left ventricu lar myocardial mass(r＝－0.36，P＜0.05).There were no statistical diff erences between all flow velocity measurements of Group A and B.Conclusions:Left ventricular hypertrophy is one of the most im portant reasons of decreased coronary flow reserve.