冠状动脉造影正常而心电图有心肌缺血改变者的相关冠状动脉血流储备功能减低

Decreased Coronary Flow Reserve in Patients With Normal Angiogram but Manifestations of Myocardial Ischemia Demonstrated by Electrocardiography

目的 :观察临床上心电图长期有心肌缺血改变但冠状动脉 (冠脉 )造影完全正常者的冠脉血流储备情况。方法 :临床上冠脉造影完全正常者 33例 ,以心电图有无缺血性ST T改变 (ST水平型或下斜型压低≥ 0 0 5mV或成组导联T波深倒置 )分为两组。甲组 17例 ,心电图有ST T改变 ,乙组 16例 ,无ST T改变。采用冠脉内多普勒导丝血流速度测定的方法计算冠脉血流储备 ,并对两组受试者的冠脉微血管病危险因素做比较分析。结果 :甲组心电图示前壁心肌缺血者的前降支血流储备以及下壁心肌缺血者的右冠脉血流储备值显著低于乙组( 2 16± 0 48vs .2 92± 0 5 2 ,P =0 0 0 2及 2 2 7± 0 5 1vs .3 40± 0 6 3,P <0 0 0 1) ,有显著性差异 ;甲组中有 14例( 82 35 % )存在冠脉血流储备的异常 ,乙组中仅有 2例 ( 12 5 0 % )存在异常 ;甲组 17例中有 13例 ( 76 47% )有冠脉微血管病基础 ,而乙组 16例中仅有 5例 ( 31 2 5 % )有冠脉微血管病危险因素 ,两组差别有统计学意义 (P =0 0 35 )。结论 :冠脉造影正常而心电图有心肌缺血改变者中 82 35 %的患者存在相关冠脉血流储备异常 。

Objective:To investigate the changes of coronary flow reserve (CFR) in patients with normal angiogram but myocardial ischemia detected by Electrocardiogram(ECG). Methods:Thirty-three patients with normal coronary angiogram were divided into two groups. Group A consisted of 17 patients,ST segments downsloping or horizontal depression≥0.05 mV or inverted T waves in several leads. Group B consisted of 16 patients,normal ECG. CFR in all subjects was analyzed. Results: CFR in left anterior descending artery of patients with anterior myocardial ischemia detected by ECG in group A was much lower than that of patients with normal ECG in group B(2.16±0.48 vs.2.92±0.52,p=0.002), and the same results were also found in the right coronary artery in groups A and B(2.27±0.51 vs.3.40±0.63,p<0.001). Fourteen of 17(82.35%) patients in group A had abnormal CFR(CFR<2.5), while only 2 of 16(12.5%) in group B. Thirteen in group A had risk factors for coronary microvasculopathy but only 5 patients in group B(p=0.035). Conclusions:The patients with normal angiography but manifestations of myocardial ischemia on ECG had decreased CFR(82.35%). It suggests that these patients have coronary microvascular disease.