冠状动脉慢血流现象的临床意义

The clinical significance of coronary slow flow phenomenon

目的:探讨冠状动脉慢血流现象的临床及近期预后价值。方法:通过矫正的TIMI血流分级方法,评价冠状动脉血流速度和远端血流灌注。对37例正常血流者和35例无冠状动脉狭窄性病变而冠状动脉慢血流者行次级量平板运动试验及心脏超声左室射血分数(LVEF)测定,并随访1年,观察近期预后。结果:冠状动脉慢血流组平板运动试验阳性率明显高于正常血流组(71.4%∶13.5%,P<0.01),而平板运动耐量时间明显低于正常血流组[(5.32±4.38)∶(10.58±5.67)min,P<0.01)];2组LVEF差异无统计学意义;随访1年发现冠状动脉慢血流组中10例反复心绞痛发作、1例发生急性下壁心肌梗死,无心脏性猝死发生。结论:冠状动脉慢血流现象与运动耐量降低、心绞痛发作有关,应引起临床重视。

Objective:To investigate the short and middle-term clinical prognosis significance in the patients with coronary slow flow phenomenon and in the patients without critical coronary arterial narrowing.Method:Thirty-seven normal subjects and 35 patients with angina pectoris and angiographic slow coronary flow were enrolled.Their coronary flow-rate and myocardial perfusion were assessed by corrected TIMI frame count(CTFC).All the patients underwent coronary angiography and submaximal exercise treadmill test and Dopple echocardiography.Their cardiac events were observed in 12 months follow-up.Result:The positive rate of submaximal exercise treadmill test were significantly higher(71.4%∶13.5%,P<0.01)and exercise tolerance were significantly lower([5.32±4.38]∶[10.58±5.67],P<0.01)in patients with coronary slow flow than that in the normal subjects.Left ventricular ejection fraction(LVEF)was lower,but there was no significant difference between the two groups.Ten patients were frequently attacked with angina pectoris and one patient was attacked with acute inferior myocardial infarction in 12 months follow-up.No one died.Conclusion:Symptom of angina pectoris and decreasing exercise tolerance were caused by coronary slow flow phenomenon.Drug treatment would be needed for the patients with coronary slow flow phenomenon.