高血压左心室肥厚与冠心病患者的冠脉血流储备

The coronary blood flow reserve in patients with hypertensive left ventricular hypertrophy and coronary heart disease

经食管超声（ＴＥＥ）研究２０例正常人（Ａ组），２２例高血压非左室肥厚病人（Ｂ组），３２例高血压左心室肥厚病人（Ｃ组）及３３例冠心病患者（Ｄ组）的冠脉血流储备（ＣＦＲ），以潘生丁静注后和静息时的舒张期最大血流速度比率（Ｄ／ＲＰＤＶ）和收缩期最大血流速度比率（Ｄ／ＲＰＳＶ）作为ＣＦＲ指标。结果发现左冠状动脉主干内径Ｃ组比Ａ、Ｂ、Ｄ组大；静息时Ｃ、Ｄ组的ＰＤＶ比Ａ组高（Ｐ＜０．０５），Ｃ、Ｄ组之间无显著性差异（Ｐ＞０．０５）；Ｃ、Ｄ组Ｄ／ＲＰＤＶ较Ａ、Ｂ组明显减少（Ｐ＜０．０１），Ｃ、Ｄ组之间无显著性差异。高血压病人的Ｄ／ＲＰＤＶ、Ｄ／ＲＰＳＶ与室间隔厚度及左室重量指数呈显著负相关。结果提示：用ＴＥＥ可检出高血压左室肥厚及冠心病病人的冠脉血流储备能力有明显减退，高血压左心室肥厚患者冠脉血流储备能力低下程度与有明确冠脉病变者相似。

Abstract Coronary blood flow reserve (CFR) was assessed by transesophageal Doppler echocardiography in normal subjects (group A, n=20), hypertensiv non-left ventricular hypertrophy (non-LVH) patients (group B, n= 22), hypertensive patients with LVH (group C, n=32) and coronary artery disease patients (group D, n=33). The ratio of dipyridamole to rest maximal diastolic velocity (D/R PDV) and dipyridamole to rest maximal systolic velocity (D/R PSV) were considered as index of coronary blood flow reserve. It was found that left main coronary artery diameter was significantly greater in group C compared with that in group A, B and D.Baseline PDV was higher in groups C and D, with no difference in PDV between groups C and D. D/R PDV was significantly less in groups C and D compared with that in groups A and B , with no significant difference in D/R PDV between groups C and D. Significant negative correlation was found between D/R PDV, D/R PSV and interseptal thickness , left ventricular mass index in hypertensive patients. These data show that impaired CFR in hypertensive patients with LVH is comparable to that in patients with coronary artery disease.