高血压患者冠状动脉血流储备下降对左心室舒张功能减退的影响

Impact of impaired coronary flow reserve on left ventricular diastolic dysfunction in patients with hypertension

目的探讨血压控制达标的高血压患者冠状动脉血流储备(CFR)对左心室舒张功能的影响。方法对86例血压控制达标、且经CAG或冠状动脉CTA证实冠状动脉狭窄<50%的高血压患者行经胸多普勒超声心动图ATP负荷试验,检测冠状动脉左前降支的CFR;测定ATP负荷前后左心室舒张功能参数,包括舒张早期、舒张晚期二尖瓣血流速度(E、A)和左心室侧壁及间隔二尖瓣环舒张早期、舒张晚期运动速度(Em、Am),分析CFR与左心室舒张功能参数的关系。结果入组患者总体CFR为2.85±0.67,其中47例CFR<3(2.35±0.40),39例CFR≥3(3.45±0.36)。CFR<3时,CFR与ATP负荷后侧壁Em呈正相关(r=0.42,P=0.003),且为ATP负荷后侧壁Em的独立影响因素(P=0.015)。结论血压控制达标且排除冠心病的高血压患者中,约50%存在冠状动脉微循环障碍;有微循环障碍的高血压患者CFR下降是左心室舒张功能减退的独立影响因素。

Objective To observe the impact of coronary flow reserve （CFR） on left ventricular （LV） diastolic function in essential hypertension patients with target blood pressure. Methods Totally 86 hypertension patients with target blood pressure and 〈50% coronary artery stenosis confirmed by CAG or CT were enrolled. CFR in left anterior descending artery was measured with adenosine triphosphate （ATP） stress transthoracic Doppler echocardiography. The indicators of LV diastolic function were measured before and after ATP stress, including the mitral early （E） and late （A） inflow velocities, early diastolic （Em）, late diastolic （Am） lateral and septal mitral annulus velocities. The correlation between CFR and LV diastolic function was analyzed. Results The mean CFR was 2.85±0.67 in all subjects. Reduced CFR （CFR〈3, 2.35±0.40） was observed in 47 patients, while 39 patients had normal CFR （CFR≥3, 3.45±0.36）. When CFR%3, it was significantly correlated to Em of LV lateral wall after ATP stress （r=0. 42, P=0. 003）, while was independently associated with Em of LV lateral wall after ATP stress （P=0. 015）. Conclusion Coronary microvascular dysfunction can be found in more than 50 % essential hypertension patients with target blood pressure but without coronary artery disease. Im paired CFR is an independent influence factor of LV diastolic dysfunction in patients with coronary microvascular dysfunction.