肥厚型心肌病冠状动脉血流动力学相关参数变化

①目的探讨肥厚型心肌病（HCM）病人冠状动脉血流动力学相关参数变化。②方法对9例非梗阻性HCM病人和11例健康志愿者应用冠状动脉内多普勒导丝测定冠状动脉左前降支（LAD）和左回旋支（LCx）血流频谱。③结果HCM组LAD的收缩期时间速度积分（STVI）明显小于对照组（t=5．66，P〈0．01），而舒张期时间速度积分（DTVI）明显大于对照组（t=2．65，P〈0．05）。HCM组中3例出现收缩期逆向血流频谱。HCM组LAD的冠状动脉血流储备（CFR）明显小于对照组（t=4．76，P〈0．01）。LCx的STVI、DTVI和CFR两组间无差异。STVI与室壁厚度呈负相关（r=-0．57，P〈0．01），而DTVI与室壁厚度呈正相关（r=0．43，P〈0．01）。LAD／LCx CFR比值与舒张末期室间隔和左室后壁厚度比值呈负相关（r=-0．67，P〈0．01）。④结论非梗阻性HCM中供应肥厚心肌的冠状动脉存在血流动力学相关参数异常，而这些变化与心肌肥厚程度有关。

CORONARY HEMODYNAMICS IN PATIENTS WITH HYPERTROPHIC CARDIOMYOPATHY

Objective To assess coronary hemodynamics in patients with hypertrophic cardiomyopathy(HCM). Methods Coronary flow velocity was measured both in the left anterior descending (LAD) and the left circumflex (LCx) arteries with a Doppler guide wire in nine patients with non-obstructive HCM and 11 control subjects with normal coronary arteries. Results (In the LAD,) systolic time velocity integra (STVI) was significantly reduced (t=5.66,P<0.01), whereas diastolic time velocity integra(DTVI) was significantly increased (t=2.65,P<0.05) in the HCM group compared with controls. A reversed systolic flow was found in three of the nine patients. Coronary flow reserve (CFR) of the LAD was significantly lower (t=4.76,P<0.01) in the HCM group than in the controls. However, there were no significant differences in STVI, DTVI, or CFR in the LCx between the two groups. In all the subjects, STVI showed significant negative correlations with ventricular wall thickness (r=-0.57, P<(0.01)), whereas DTVI showed significant positive correlations with ventricular wall thickness (r=0.43, P<0.01). Additionally, there was a significant negative correlation between LAD/LCx CFR ratio and interventricular septal/posterior wall thickness ratio (r=-0.67, P<0.01). Conclusion In patients with HCM, abnormal coronary flow dynamics exists in the artery supplying hypertrophied myocardium and correlates with the degree of hypertrophy.