肺动脉高压对冠状静脉窦血流动力学的影响

Coronary hemodynamic changes in patients with pulmonary hypertension

目的 探讨肺动脉高压对冠状静脉窦血流动力学的影响。方法 正常对照组和肺动脉高压组各30例。应用多平面经食管超声心动图技术测量冠状静脉窦收缩期、舒张期、心房收缩期冠状静脉窦血流速度峰值(CSS、CSD、CSA )及流速积分( VTI CSS、VTI CSD、VTI CSA),并计算冠状静脉窦净前向血流流速积分(VTInet)、净前向血流量(CSF)。结果 与正常对照组比较,肺动脉高压组冠状静脉窦内径明显增宽[(12.24±2.93)mm 对 (7.22±0.89) mm, P < 0.001 ]; CSS、CSA、VTI CSS、VTI CSA、VTInet、CSF 明显增加[ CSS(74.07±21.58)cm/s 对 (37.01±23.41)cm/s,P<0.001;CSA(36.89±9.62)cm/s 对 (20.69±6.17)cm/s, P<0.001;VTI CSS (9.79±3.82)cm 对 (4.73±2.38) cm, P < 0.001; VTI CSA (2.14±0.69) cm 对 (1.50±0.30)cm,P<0.01;VTInet (13.98±4.55)cm 对 (8.56±2.41)cm, P<0.001;CSF (1272.1±439.24)cm 对(738.2±245.02)cm,P<0.001],CSD、VTI CSD差异无显著性意义。结论 肺动脉高压时冠状循环血流动力学发生了显著改变,表现为冠状静脉窦扩张,血流速度和流量增加。

Objective To estimate hemodynamic changes of coronary sinus in the patients with pulmonary hypertension(PH).Methods Control group included thirty normal subjects,PH group included thirty patients with unexplained PH.Coronary sinus hemodynamic parameters including maximal systolic,diastolic antegrade flow velocity (CSS,CSD),maximal retrograde flow velocity at atrial contraction (CSA),and respective flow velocity time integral (VTI-CSS,VTI-CSD,VTI-CSA) were measured by multi-plane transesophageal echocardiography.Net forward flow velocity time integral (VTInet) was calculated as antegrade minus retrograde flow velocity time integral,and VTInet multiplied by heart rate was calculated as index of coronary forward flow (CSF).Results Coronary sinus diameter was larger [( 12.24± 2.93)mm vs ( 7.22± 0.89)mm,P< 0.001] in patients with PH than that in control subjects.CSS,CSA,VTI-CSS,VTI-CSA,VTInet,CSF were higher [CSS ( 74.07± 21.58)cm/s vs ( 37.01± 23.41)cm/s,P< 0.001; CSA ( 36.89± 9.62)cm/s vs ( 20.69± 6.17)cm/s,P< 0.001; VTI-CSS ( 9.79± 3.82)cm vs ( 4.73± 2.38)cm,P< 0.001; VTI-CSA ( 2.14± 0.69)cm vs ( 1.50± 0.30)cm,P< 0.01; VTInet ( 13.98± 4.55)cm vs ( 8.56± 2.41)cm,P< 0.001; CSF ( 1272.1± 439.24)cm vs ( 738.2± 245.02)cm, P< 0.001] in the patients with PH than those in control subjects.Conclusions There are structural and hemodynamic changes in coronary sinus in the patients with PH,which are characterized by the dilation of coronary sinus and the increase of its flow velocity and forward flow.