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首页> 外文期刊>Rheumatology >Mechanism of coronary flow reserve reduction in systemic sclerosis: insight from intracoronary pressure wire studies.
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Mechanism of coronary flow reserve reduction in systemic sclerosis: insight from intracoronary pressure wire studies.

机译：全身性硬化中冠状动脉血流储备减少的机制：冠状动脉内压力线研究的真知灼见。

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OBJECTIVE: Functional impairment of coronary microcirculation is thought to be a major pathway in the development of primary cardiac involvement in SSc; however, the underlying mechanism is not fully understood. We aimed to investigate the mechanisms of coronary flow reserve (CFR) reduction in patients with SSc. METHODS: Seventeen SSc patients and 17 gender- and age-matched controls were enrolled. Coronary angiography and determination of coronary flow parameters including index of myocardial resistance (IMR) using intracoronary pressure wire at basal conditions and during vasodilator-induced maximal hyperaemia were performed. Transit times of repeated intracoronary saline injection were measured to evaluate the role of cold exposure. RESULTS: SSc patients with decreased CFR had accelerated basal coronary flow velocity (P < 0.05), and their IMR in hyperaemia (IMR(hyp)) did not differ from either SSc patients with normal CFR or from the controls (P = 0.292 and P = 0.308). The coronary flow velocity of SSc patients correlated with the IMR at baseline (IMR(bas)) (r = 0.56, P = 0.019). Injection of room temperature saline did not provoke changes in coronary transit times. CONCLUSIONS: The lack of decrease in the maximal vasodilatation response indicates that there is no irreversible functional damage at the level of the coronary arterioles. In patients with reduced CFR, the decreased basal IMR and higher velocity reflect compensatory vasodilatory mechanisms probably triggered by ischaemic signals deriving from abnormal myocardial microcirculation.
机译：目的：冠状动脉微循环功能障碍被认为是SSc原发性心脏受累的主要途径。但是，其底层机制还没有被完全理解。我们旨在调查SSc患者冠状动脉血流储备（CFR）减少的机制。方法：纳入17名SSc患者和17名性别和年龄匹配的对照。在基础条件下以及在血管扩张剂引起的最大充血期间，使用冠状动脉内压线进行冠状动脉造影和确定冠状动脉血流参数，包括心肌阻力指数（IMR）。测量重复冠状动脉盐水注射的转运时间，以评估冷暴露的作用。结果：CFR降低的SSc患者的基础冠状动脉血流速度加快（P <0.05），其充血的IMR（IMR（hyp））与CFR正常的SSc患者或对照组的患者无差异（P = 0.292和P = 0.308）。 SSc患者的冠状动脉流速与基线时的IMR相关（IMR（bas））（r = 0.56，P = 0.019）。注射室温盐水不会引起冠状动脉转运时间的改变。结论：最大血管舒张反应没有降低，表明在冠状动脉水平上没有不可逆的功能损伤。在CFR降低的患者中，基础IMR的降低和较高的速度反映了代偿性血管舒张机制，这可能是由异常的心肌微循环产生的缺血信号触发的。

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