冠状动脉痉挛患者~(201)Tl心肌灌注显像反向再分布与血管内皮功能紊乱的关系

目的:探讨冠状动脉痉挛患者在201Tl(铊)心肌灌注显像负荷试验中的反向再分布现象与血管内皮功能的关系。方法:选择接受201Tl心肌灌注显像负荷试验的患者为研究对象,根据最后临床诊断将患者分为冠状动脉痉挛组(n=30)、冠心病组(n=30)和对照组(n=30),分别在201Tl心肌灌注显像心肌负荷试验前、负荷试验后即刻(负荷显像)及负荷后3h(再分布显像)时采集外周静脉血测定并比较各组间及不同时点内皮素-1、一氧化氮水平以及内皮素-1/一氧化氮比值的动态变化,组间比较采用方差分析进行统计学处理。结果:负荷试验前,冠状动脉痉挛组内皮素-1水平[(163.53±8.58)pg/ml]高于对照组[(116.15±6.65)pg/ml,P0.01]及冠心病组[(137.73±8.32)pg/ml,P0.01],一氧化氮水平[(60.32±8.20)μmol/L]低于对照组[(70.10±6.90)μmol/L,P0.05]亦略低于冠心病组[(62.64±7.45)μmol/L,P=0.238],内皮素-1/一氧化氮比值(2.75±0.39)显著高于对照组(1.67±0.18,P0.01)及冠心病组(2.22±0.31,P0.05)。负荷试验后即刻,冠状动脉痉挛组较对照组内皮素-1水平降低[(151±9.15)pg/ml,P0.01]、一氧化氮水平升高[(63.78±8.30)μmol/L,P0.01]、内皮素-1/一氧化氮比值降低(1.40±0.12,P0.01);负荷后3h,冠状动脉痉挛组内皮素-1恢复至负荷前水平,一氧化氮降低且低于负荷前水平,内皮素-1/一氧化氮比值升高且高于负荷前水平,从而有利于血管收缩;对照组在负荷后即刻内皮素-1/一氧化氮比值较负荷前水平轻度降低,3h后回到负荷前水平;而冠心病组在负荷试验中的内皮素-1/一氧化氮比值差异无统计学意义。结论:冠状动脉痉挛患者的反向再分布可能与内皮细胞功能紊乱所引起的病变血管在静息状态下痉挛及负荷时扩张、从而导致心肌血流灌注改变有关。     

非典型性冠状动脉痉挛患者的临床特点及近期预后

目的总结非典型性冠状动脉痉挛患者的临床特点。方法选择临床具有静息性胸痛或胸闷,且冠状动脉造影无显著狭窄的64例患者进行乙酰胆碱冠状动脉痉挛激发试验,将乙酰胆碱试验阳性即冠状动脉痉挛患者根据胸痛或胸闷发作时心电图上是否有ST段抬高分为典型变异型心绞痛组（典型组）和非典型变异型心绞痛性冠状动脉痉挛组（非典型组）,比较两组的临床症状特点（危险因素、心电图和核素心肌灌注显像负荷试验结果以及冠状动脉造影和乙酰胆碱试验的影像学）。结果共有46例（72％,46／64）患者诱发冠状动脉痉挛,其中典型组和非典型组分别为12及34例。典型组的平均年龄偏低（P〈0．05）,血脂代谢紊乱在非典型组更常见,运动心电图试验两组多为阴性,核素灌注心肌显像负荷试验两组均表现有反向再分布,冠状动脉造影典型组多为轻度局限性狭窄或节段性内膜不光滑,肌桥发生率更高,乙酰胆碱试验多诱发节段性痉挛。而非典型组为弥漫性血管细小、内膜不光滑、僵硬,血管迂曲伴远端血流缓慢,乙酰胆碱试验多诱发弥漫性血管痉挛,并可见多支血管同时痉挛。结论非典型性冠状动脉痉挛较典型变异型心绞痛更常见,且具有一定的特征性,应引起临床医生高度重视。     

三磷酸腺苷负荷~(99m)锝—甲氧基异丁基异腈门控心肌灌注显像在评价心肌桥引起心肌缺血患者中的临床价值

目的:探讨三磷酸腺苷(ATP)负荷99m锝—甲氧基异丁基异腈(99mTc-MIBI)门控心肌灌注显像(G-MPI)对评价心肌桥患者心肌缺血的程度、部位及心功能的临床价值。方法:选择58例以冠状动脉造影或冠状动脉计算机断层血管造影术(CTA)明确诊断为心肌桥的患者,行ATP负荷99mTc-MIBI G-MPI检查,将左心室心肌短轴及垂直长轴像划分为13个节段,应用目测法按0~3分4阶法半定量评价左心室心肌各节段核素分布情况,计算左心室负荷总积分,判定心肌桥患者心肌缺血的程度及部位,并与心肌桥的严重程度进行对比。同时分析ATP负荷99mTc-MIBI G-MPI得出的左心室射血分数(LVEF)与经胸彩色多普勒超声心动图获得的LVEF的相关性。结果:ATP负荷99mTc-MIBI G-MPI对心肌桥患者心肌缺血的检出率为82.76%,动态心电图的检出率为56.10%,前者明显高于后者(P0.05)。ATP负荷99mTc-MIBI G-MPI显像中冠状动脉左前降支支配区域核素分布异常为258个节段(63.55%),冠状动脉左回旋支支配区域核素分布异常为82个节段(47.13%),右冠状动脉支配区域核素分布异常为74个节段(42.53%),冠状动脉左前降支支配区域核素分布异常节段数明显高于左回旋支及右冠状动脉(P0.0125)。在58例心肌桥患者,ATP负荷99mTc-MIBI G-MPI定量分析中得出的静息状态下LVEF为(69.59±4.13)%,经胸彩色多普勒超声心动图测得的LVEF为(63.22±4.12)%,二者差异无统计学意义(P0.05),且呈明显正相关性(r=0.555,P0.05)。结论:ATP负荷99mTc-MIBI GMPI可以较直观准确地评价心肌桥患者的心肌缺血程度、部位及左心功能,对临床治疗具有一定的指导价值。     

乙酰胆碱诱发冠状动脉痉挛时的心电图改变及其与血管内皮功能关系

目的探讨血管内皮细胞功能紊乱与乙酰胆碱试验诱发冠状动脉痉挛时心电图ST段变化与缓慢型心律失常的关系。方法选择以静息性胸痛为主要临床表现、接受乙酰胆碱激发试验的患者为研究对象,根据是否发生冠状动脉痉挛分为阳性组和阴性组,冠状动脉痉挛发作时心电图变化分为ST段抬高和非ST段抬高组以及缓慢型心律失常和无缓慢型心律失常组,测定其血浆一氧化氮和内皮素1浓度,比较各组一氧化氮和内皮素1水平以及痉挛血管的分布。结果ST段抬高组一氧化氮水平显著低于阴性组,而内皮素1显著高于阴性组(P<0.01),非ST段抬高组一氧化氮水平亦显著低于阴性组,但高于ST段抬高组(P<0.05),而内皮素1显著高于阴性组但低于ST段抬高组(P<0.05);缓慢型心律失常组和无缓慢型心律失常组的血浆一氧化氮和内皮素1水平以及痉挛血管的分布差异无统计学意义(P>0.05)。结论乙酰胆碱试验诱发的冠状动脉痉挛以及ST段变化与血管内皮细胞功能紊乱有关,乙酰胆碱试验中的缓慢型心律失常与血管内皮细胞功能或痉挛血管的分布无关。     

血管活性物质与桡动脉痉挛关系的配对病例对照研究

目的桡动脉痉挛是经桡动脉介入诊疗中最常见的并发症。本研究初步探讨血管活性物质和桡动脉痉挛的关系,为临床桡动脉痉挛的预防提供理论依据。方法本研究为前瞻性、配对病例对照研究。所有患者均为仅接受经桡动脉冠状动脉造影的患者,按照性别相同,年龄相差2岁以内进行1:2配对。痉挛的判断使用临床桡动脉痉挛的定义。检测两组患者血清一氧化氮、内皮素-1、前列环素、血栓素A2、去甲肾上腺素浓度,并多因素回归分析桡动脉痉挛发生的危险因素。结果入选60例发生桡动脉痉挛的单纯冠状动脉造影患者,配对入选120例未发生桡动脉痉挛的单纯冠状动脉造影患者。痉挛组和对照组中一氧化氮[(63.5875±21.2763)μmol/L比(55.6425±18.1542)μmol/L,F=7.442,P=0.351]和血栓素A2[(0.9768±0.1953)ng/ml比(0.7824±0.2051)ng/ml,F=1.058,P=0.284]浓度差别没有统计学意义,内皮素-1[(298.5839±65.3291)ng/ml比(81.4391±20.4283)ng/ml,F=2.034,P<0.001]和去甲肾上腺素[(202.3721±38.3829)ng/ml比(56.4828±15.6025)ng/ml,F=39.267,P=0.005]高于对照组,前列环素[(8.8294±2.5322)pg/ml比(15.5430±4.8267)pg/ml,F=14.586,P=0.038]低于对照组。多因素回归分析发现,内皮素-1(OR2.954,95%CI1.569～5.354,P=0.005)和去甲肾上腺素(OR4.642,95%CI2.619～8.332,P=0.018)是术中发生桡动脉痉挛的危险因素。结论内皮素-1和去甲肾上腺素浓度是术中桡动脉痉挛发生的危险因素。     

冠状动脉造影正常的老年高血压患者负荷试验的分析

目的　探讨老年高血压患者冠状动脉储备功能 (CFR)。方法　冠状动脉造影正常的高血压患者 76例 ,无左心室肥厚 (LVH) 32例 (Ⅰ组 ) ,合并LVH44例 (Ⅱ组 ) ,正常对照组 2 6例 (Ⅲ组 )。三组受检者分别行静态、运动心肌核素断层显像及心电图潘生丁负荷试验。结果　心肌核素显像 :Ⅰ组运动后单光子发射型计算机断层仪 (ECT)呈缺血性改变 3例 (9.4% ) ,Ⅱ组运动后ECT呈缺血性改变 11例 (2 5 .0 % ) ,有反向再充填现象 2例 (4.5 % ,P <0 .0 5 )。心电图潘生丁试验 :Ⅰ组阳性 1例 (3.1% ) ,可疑阳性 3例 (9.4% ) ;Ⅱ组阳性 7例 (15 .9% ) ,可疑阳性 9例(2 0 .5 % ,P<0 .0 5 )。心电图潘生丁试验阳性或可疑阳性伴ECT缺血性改变 :Ⅰ组 :无 ;Ⅱ组 8例 (18.2 % ,P <0 .0 1)。正常对照组心肌核素显像及潘生丁试验均无异常。结论　高血压患者存在不同程度CFR下降 ,合并LVH尤为明显 ,其原因可能与冠状动脉微循环结构及功能异常有关。     

腺苷负荷心肌灌注显像对冠状动脉介入治疗的临床意义

目的:探讨腺苷负荷心肌灌注显像对冠状动脉(冠脉)介入治疗的临床意义。方法:66例冠心病患者,行腺苷负荷心肌灌注显像和冠脉造影,根据需要进行介入治疗,介入治疗后3～7天复查腺苷负荷心肌灌注显像。腺苷负荷心肌灌注显像采用单光子发射断层显像图像采集系统,腺苷注射液总量为840μg/kg,6分钟匀速静脉泵入,腺苷泵入3分钟时静脉推注99锝-2-甲氧基异丁基异腈核素(99mTc-MIBI);1.5h后进行心肌灌注断层显像。若异常,次日行静息心肌显像。核素显像左心室心肌分为9个节段,心肌灌注评分分4级。结果:66例患者的腺苷负荷心肌灌注显像与冠脉造影结果相比,双支病变腺苷负荷心肌灌注显像阳性率(87.5%,28/32)和三支病变腺苷负荷心肌灌注显像阳性率(100%),与冠脉造影阳性率(100%)比较差异均无统计学意义(P0.05);单支病变腺苷负荷心肌灌注显像阳性率为54.5%(12/22),与冠脉造影阳性率(100%)比较差异有统计学意义(P0.01)。双支病变和三支病变腺苷负荷心肌灌注显像阳性率分别与单支病变相比,差异均有统计学意义(P均0.05)。冠脉介入后心肌核素显像血流灌注改善率为94.1%(32/34),与冠状动脉介入前(0%,0/34)自身对照,差异有统计学意义(P=0.003)。结论:腺苷负荷心肌灌注显像对于冠心病患者冠脉介入前病变程度分析以及介入后疗效判断有一定的临床意义。     

肌钙蛋白Ⅰ和心肌灌注对无冠状动脉粥样硬化性心脏病的肥厚型心肌病的临床意义

目的探讨无冠状动脉粥样硬化性心脏病(冠心病)的肥厚型心肌病患者心肌肌钙蛋白I(c Tn I)水平与磁共振心肌灌注延迟显像(LGE)及核素心肌灌注/代谢显像(PET-CT)的关系。方法连续入选自2016年5月至2017年4月在阜外医院进行住院治疗的无冠心病的肥厚型心肌病患者共80例。根据c Tn I水平分为c Tn I正常组和c Tn I异常组两组进行比较。结果所有患者的平均年龄47.3±14.3岁,男性占全部患者的68.7%,c Tn I异常的患者占57.5%。c Tn I异常组与c Tn I正常组相比室壁最厚厚度更厚(22.6±6.3 mm vs.20.6±5.8 m m,P=0.043),总胆红素水平(19.7μmol/L vs.15.6μmol/L,P=0.011)更高、超敏C反应蛋白(2.6 mg/L vs.1.0mg/L,P0.001)及大内皮素-1(5.1 pmol/L vs.4.0 pmol/L,P=0.039)均偏高,PET-CT心肌代谢显像提示非节段性、散在的放射性核素分布稀疏、缺损者更多见(22.2%vs.7.2%,P=0.016),LGE阳性率更高(54.3%vs.32.4%,P=0.042),而NT-pro BNP水平及是否合并梗阻在两组间未发现差异。结论 c Tn I水平及核素心肌灌注/代谢显像有利于对无冠心病的肥厚型心肌病患者的临床评价和管理;c Tn I水平升高与疾病的严重程度和心肌灌注不足可能相关,未来的研究应该进一步评估c Tn I和心肌灌注/代谢与临床预后的关系,以期能进一步改善危险分层。     

门控核素心肌灌注显像预测冠状动脉介入治疗疗效的价值

目的:探讨~(99m)Tc-甲氧基异丁基异腈(MIBI)门控核素心肌灌注显像(G-MPI)在预测冠状动脉介入治疗(冠状动脉支架置入术)疗效方面的价值.方法:30例接受经皮冠状动脉支架置入术的冠心病患者均在支架置入术前1周及随访期内(5.67±3.23个月)完成两日法负荷/静息G-MPI,在支架置入术和随访核素心肌灌注显像之间无主要不良心脏事件的发生,比较术前及随访期的G-MPI定性和定量分析的结果.结果:G-MPI示支架置入术后缺血心肌节段数[(1.77±2.06)个]明显少于术前[(4.57±2.93)个](P=0.000),梗死心肌节段数则无显著差异(P=0.599).支架术后总负荷评分和负荷静息评分差值较术前明显降低(P值分别为0.001和0.002).支架置入术后,患者的LVEF由(56.43±16.59)%升高至(62.50±19.05)%(P=0.003),左室舒张末容积和左室收缩末容积均明显降低(P分别为0.005和0.000).结论:术前行核素心肌显像判断缺血存活心肌的情况,可以对支架置入术的疗效进行较为准确的预测,门控采集所获得的心室功能和容积也有助于对患者进行危险度分层.     

腺苷负荷心肌灌注显像在冠心病诊断中的应用

目的:评价腺苷负荷心肌灌注显像试验对冠心病的诊断价值。方法:60例住院患者均行腺苷负荷心肌灌注显像和冠状动脉造影(CAG),腺苷以0.14mg/(kg.min)的速度外周静脉输入,第3分钟时,静脉注射放射性核素99mTc-MIBI740MBq,1.5h后进行心肌断层显像,若异常,次日行静息心肌显像,分析腺苷负荷试验心肌核素显像对于冠心病诊断的敏感性、特异性及其特点。结果:CAG阳性42例中,心肌核素显像阳性37例(敏感性88%)。18例CAG无明显狭窄,其中13例心肌核素显像阴性(特异性为72%)。前降支病变36例,心肌核素前壁区域低灌注20例,回旋支病变22例,侧壁区域低灌注14例,右冠脉病变28例,下壁区域低灌注27例,右冠脉病变较前降支或回旋支病变的心肌核素显像阳性率高(P0.05)。在应用过程中,腺苷未出现明显不良反应。结论:腺苷负荷试验心肌核素灌注显像对于冠心病诊断的敏感性、特异性较高,对诊断冠心病具有重要意义。     

急性下壁心肌梗死伴V_(1～3)和V_(4～6)导联ST段压低的临床意义

目的 :探讨急性下壁心肌梗死 (MI)时前壁 V1～ 3 和 V4～ 6 导联 ST段压低的临床意义。方法 :回顾性分析 5 9例首发急性下壁 MI患者的心电图和冠状动脉造影资料。分为 3组 :组 1:急性下壁 MI不伴前壁导联 ST段压低 (30例 ) ;组 2 :急性下壁 MI伴前壁 V1～ 3导联 ST段压低 (15例 ) ;组 3:急性下壁 MI伴前壁 V4～ 6 导联 ST段压低 (14例 )。结果 :组 2的左旋支狭窄 (≥ 70 % )例数明显多于另外两组 (6 0 % vs 2 7%、2 8% ,P <0 .0 5 ) ,其多支血管病变较多 (10 .0 %、2 8.6 % vs6 6 .7% ,P<0 .0 5 ) ,肌酸激酶同工酶峰值较高 [(173.78± 5 8.83) U/ L 、(16 4.2 2± 38.12 ) U/ L vs(2 39.6 5± 45 .34) U/ L,P <0 .0 5 ],左室射血分数较低 [(6 1± 7) %、(5 6± 5 ) % vs(4 5±10 ) % ,P <0 .0 5 ]。组 1与组 3相比 ,两者的各种参数差异无显著性意义 (P >0 .0 5 )。结论 :急性下壁 MI伴 V1～ 3导联 ST段压低提示和左旋支的病变有关 ,其 MI面积较大、射血分数较低。     

联合心脏负荷试验对非典型胸痛患者鉴别诊断的意义

目的探讨利用心电图运动试验（S-ECG）和核素灌注心肌显像负荷试验（S-MPS）在非典型胸痛患者临床诊断中的价值。方法对非典型胸痛为主诉、临床诊断明确且S-ECG、S-MPS、冠状动脉（冠脉）造影和冠脉痉挛激发试验资料完整的患者为研究对象,回顾性分析两种负荷试验结果并与最后诊断进行对照分析。结果资料完整的186例非典型性胸痛患者,最后诊断冠心病患者占20％,冠脉痉挛占27％,冠脉肌桥占14％,X综合征5％,非冠脉疾病占34％。在除外冠脉痉挛后,S-ECG诊断冠脉缺血性病变的敏感性和特异性分别为92％和65％;S-MPS的敏感性和特异性分别为62％和79％。非典型胸痛患者中S-ECG阴性,但S-MPS呈反向再分布诊断冠脉痉挛的敏感性和特异性分别为94％和96％。结论非典型胸痛患者中多数具有缺血意义的冠脉病变基础,联合负荷试验对鉴别诊断具有重要临床价值。     

冠心病患者单核细胞组织因子的表达

目的：测定冠心病患单核组织因子的表达,并评价它与冠心病活动性之间的关系。方法：用免疫荧光技术和流式细胞术,测定稳定型心绞（ＳＡＰ组）,不稳定型心绞痛（ＵＡＰ组）,急性心肌梗死（ＡＭＩ组）患和健康受定（对照组）循环中单细胞组织因子的表达。结果：ＳＡＰ试（对照组）和ＡＭＩ组单核细胞组织因子的表达均高于对照组,组织因子的表达与冠心病的活动性显相关。结论：冠心病患循环中,单核细胞组织因子的表达增强与冠心病的心病患血液呈血液呈高凝状态的原因之一。     

急性冠状动脉综合征患者外周血树突状细胞亚群数量及比例的变化

目的 本研究探讨冠心病患者外周血树突状细胞(DC)亚群数量及比例的变化及意义.方法 选择我院2006年1-12月共60例行冠状动脉支架术治疗的冠心病患者(急性心肌梗死20例、不稳定性心绞痛20例和稳定性心绞痛20例),以同时冠状动脉造影正常的11例胸痛综合征患者为对照,以其他非冠心病的住院患者10例为正常对照.采用四色荧光标记技术对外周血髓样DC和浆细胞样DC占外周血单核细胞比例进行流式细胞术测定.结果 不稳定性心绞痛组和急性心肌梗死组髓样DC占外周血单核细胞比例(分别为4.7%±2.6%,5.0%±2.7%)低于正常对照组、胸痛组和稳定性心绞痛组(分别为12.0%±3.9%,12.3%±3.3%和11.0%±6.4%,均P＜0.001),髓样DC实际数量水平降低(41.0±28.3,45.8±25.2比84.4±37.3,81.2 ±34.8,73.2±42.2,均P＜0.001);但外周血浆细胞样DC亚群占外周血单核细胞的比例和实际数量各组间比较,差异无统计学意义.结论 急性心肌梗死和不稳定心绞痛患者外周血髓样DC比例及数量下降,表明在急性冠状动脉综合征患者外周血中DC亚群分布异常,髓样DC的下降与动脉粥样硬化进展高度相关.     

Two cases of variant form angina pectoris associated with myocardial bridge--a possible relationship among coronary vasospasm, atherosclerosis and myocardial bridge.

Myocardial bridge (MB) is a congenital anomaly of the coronary artery and may occur in 5 to 12% of the human population. However, the mechanism of MB-induced myocardial ischemia is still speculative. We report 2 cases of variant form angina pectoris associated with MB in which myocardial ischemia seemed to be related to the interaction between coronary perfusion and MB. In case 1, electrocardiography during anginal attack at rest showed ST elevation in the inferior leads and MB was observed after percutaneous transluminal coronary angioplasty at the site of the right coronary artery lesion following successful dilatation. In case 2, MB of the left anterior descending coronary was located in the identical portion where coronary vasospasm was induced by intracoronary acetylcholine injection, although ischemia during the spontaneous anginal attack was limited to the inferior area of myocardium. These 2 cases suggest that MB can be, at least in some patients, one of the possible causes of the endothelial damage which seems to be related to coronary vasospasm; this was documented in both cases.     

Resting Chest Pain, Negative Treadmill Exercise Electrocardiogram, and Reverse Redistribution in Dipyridamole Myocardial Perfusion Scintigraphy Might be the Features of Coronary Artery Spasm

BACKGROUND: Coronary artery spasm usually attacks while at rest and the diagnosis depends on provoking tests which mostly are invasive, expensive and not practical. Previous investigations demonstrated that in most patients with coronary artery spasm, treadmill exercise electrocardiography (TEEC) did not induce any ischemic changes, and myocardial perfusion scintigraphy (MPS) showed reverse redistribution (RR). HYPOTHESIS: Combination of resting chest pain, negative TEEC and RR might be a rational noninvasive set to predict coronary artery spasm. METHODS: Patients with chest pain at rest, no significant coronary artery stenosis, and willing to undergo acetylcholine test were included. TEEC, dipyridamole and rest thallium-201 MPS were performed before or after coronary angiography. The patients were divided into spasm and nonspasm groups by acetylcholine test. The clinical features and results of TEEC and MPS were compared between the spasm and nonspasm groups. RESULTS: Acetylcholine test was performed in 92 patients and coronary artery spasm was successfully provoked in 68 patients. Positive TEEC was induced in only 4 patients in the spasm group. RR was present in totally 77 patients and 68 of them were from the spasm group. By a combination of resting chest pain, negative TEEC and RR to diagnose coronary artery spasm, the sensitivity and specificity were 94% and 96% respectively. CONCLUSION: Combination of resting chest pain, negative TEE and RR appears to be a rational noninvasive set to predict coronary artery spasm.     

Increased plasma level of endothelin-1-like immunoreactivity during coronary spasm in patients with coronary spastic angina

To examine the role of endothelin in coronary spasm, the plasma endothelin-1-like immunoreactivity in the coronary sinus and the aortic root was measured before and during spasm of the left coronary artery induced by injection of acetylcholine (20 to 100 micrograms) into the left coronary artery in 26 patients with coronary spastic angina. The plasma level of endothelin-1-like immunoreactivity was measured by the radioimmunoassay with a monoclonal antibody against endothelin-1. Plasma lactate levels in the coronary sinus and the aortic root were also measured to evaluate myocardial lactate metabolism during spasm. In 13 patients who had myocardial lactate production during spasm, the plasma level of endothelin-1-like immunoreactivity in the coronary sinus increased from 19.8 +/- 3.0 to 25.7 +/- 6.4 pg/ml (p less than 0.01), while that in the aortic root remained unchanged (from 20.2 +/- 5.9 to 21.3 +/- 5.8 pg/ml). No significant changes in the plasma levels of endothelin-1-like immunoreactivity in the coronary sinus (from 21.1 +/- 7.3 to 19.7 +/- 5.2 pg/ml) and the aortic root (from 21.1 +/- 5.7 to 19.7 +/- 5.6 pg/ml) were observed in 13 patients who did not show myocardial lactate production during spasm. On the other hand, 16 patients without ischemic heart disease showed no significant changes in the plasma levels of endothelin-1-like immunoreactivity in the coronary sinus (from 24.4 +/- 9.7 to 25.8 +/- 6.9 pg/ml) and the aortic root (from 23.0 +/- 7.1 to 23.4 +/- 5.8 pg/ml) by acetylcholine injection (100 micrograms).(ABSTRACT TRUNCATED AT 250 WORDS)     

Does isolated myocardial bridge really interfere with coronary blood flow?

BackgroundMyocardial bridge (MB) is defined as a segment of a major epicardial coronary artery the “tunneled artery” that goes intramurally through the myocardium beneath the muscle bridge. Multiple methods have been proposed to assess coronary flow rate among which thrombolysis in acute myocardial infarction frame count was a relatively new semiquantitative method.ObjectivesOur goal was to determine incidence of MB in the patients undergoing coronary angiography in Mansoura Specialized Hospital, Cardiac Catheterization Laboratory, also to investigate the hypothesis that slow coronary flow rate may be linked to angina or angina like symptoms in patients with MB without stenotic lesions in epicardial coronary arteries using TFC.Patients and methodsFifteen patients with MB (group I) were retrospectively collected from Mansoura Specialized Hospital, Cardiac Catheterization Laboratory, we review 3000 cases referred to diagnostic coronary angiography to exclude significant coronary artery disease. Fifteen patients with normal coronary angiography served as control (group II). We review the clinical presentations, risk factors, echocardiographic data for both test and control groups. TFC was calculated using a simple continuous index.ResultsThe incidence of MB in our study was 0.5%. CTFC in LAD was significantly higher in the patients with MB compared with control. No significant correlation between TFC and echocardiographic parameters.ConclusionsMyocardial bridging must be considered especially in patients at low risk for coronary atherosclerosis but with angina like chest pain or established myocardial ischemia. We suggest that coronary blood flow is decreased in the patients with MB compared with the patients having normal coronary.     

Coronary Artery Spasm: Use of Ergonovine in Diagnosis *

Summary: Coronary artery spasm: Use of ergo ovine in diagnosis. S. B. Freedman, R. F. Dunn, L. Bernstein, D. R. Richmond, G. O'Neill and D. T. Kelly, Aust. N.Z. J . Med., 1 980, 10 , pp. 6–11.
Ergo ovine male ate was administered to 69 patients with chest pain but without significant coronary artery disease (<70% luminal diameter obstruction) to determine whether coronary artery spasm could be provoked. Coronary artery spasm was seen at angiography, or inferred from ECG or thallium myocardial perfusion scan changes. The test was positive in 76 patients: all five patients with documented variant angina (Group A); ten of the 19 patients with suspected variant angina (Group 6); one of the 11 patients with exercise-induced chest pain (Group C); and none of the 34 patients with atypical chest pain (Group D). Patients with a positive test usually smoked, complained of recurrent nocturnal or early morning chest pain, showed ST changes during spontaneous chest pain and had minor degrees of fixed coronary obstruction (30–70%), when compared to those with a negative test. The only major side effect of the test was transient ventricular tachycardia which occurred in three patients and was reverted by sublingual and paranormal nitroglycerine.