Early Alteration of Coronary Hemodynamics in Late Restenosis after Coronary Angioplasty
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概要
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It is not known whether changes in coronary hemodynamics may antedate the development of restenosis after percutaneous coronary transluminal angioplasty (PTCA). The purpose of this study was to evaluate the early change in coronary microvascular function in patients with late restenosis after PTCA. Coronary hemodynamics were studied in series before, immediately after, 2 weeks and 3 months after successful PTCA in 12 male patients with a single lesion of the left anterior descending coronary artery. In each patient, great cardiac venous flow (GCVF) and oxygen content were measured both at baseline and during hyperemia induced by adenosine infusion. The sequential changes of coronary hemodynamics were compared between patients with and without restenosis at 3 months after PTCA. Basic characteristics did not differ between the patients with (n = 6) and those without restenosis (n = 6). Luminal diameter stenosis (in percentage) was also similar between the two groups both before (79.2 ± 18.4% vs 83.0 ± 9.6%, p = NS) and up to 2 weeks after PTCA (25.8 ± 10.9% vs 28.5 ± 7.9%, p = NS). In patients without restenosis, basal and hyperemic GCVF was unchanged up to 2 weeks after PTCA. There was a significant increase in CFR 3 months after PTCA. In patients with restenosis, basal GCVF was significantly increased and hyperemic GCVF was unchanged immediately after PTCA. However, 2 weeks after PTCA, basal GCVF was decreased while luminal diameter was still preserved. In comparison with those without restenosis, patients with restenosis had significantly lower CFR before (1.98 ± 0.42 vs 2.69 ± 0.46, p = 0.019), immediately after (1.47 ± 0.27 vs 2.24 ± 0.47, p = 0.006) and 3 months after PTCA (1.51 ± 0.32 vs 3.40 ± 0.54, p = 0.001). In patients without restenosis, the recovery of coronary microvascular function was delayed up to 3 months after PTCA. In patients with late restenosis, basal coronary microvascular tone was altered within 2 weeks after PTCA suggesting early deterioration of coronary microvascular function before the development of angiographic restenosis.
著者
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Chen Jaw-wen
Division Of Cardiology Department Of Internal Medicine Taipei Veterans General Hospital
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Wu Tao-cheng
Division Of Cardiology Department Of Internal Medicine Taipei Veterans General Hospital
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CHEN Ching-Iuan
Division of Cardiology, Department of Medicine, Veterans General Hospital
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HSU Nai-Wei
Division of Cardiology, Department of Medicine, Veterans General Hospital
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WANG Shih-Pu
Division of Cardiology, Department of Medicine, Veterans General Hospital
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CHANG Mau-Song
Division of Cardiology, Department of Internal Medicine, Veterans General Hospital-Kaohsiung and Taipei
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MAR Guang-Yuan
Division of Cardiology, Department of Internal Medicine, Veterans General Hospital-Taipei and National Yang-Ming University School of Medicine, Taipei, Taiwan
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CHEN Ying-Hwa
Division of Cardiology, Department of Internal Medicine, Veterans General Hospital-Taipei and National Yang-Ming University School of Medicine, Taipei, Taiwan
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DING Yu-An
Division of Cardiology, Department of Internal Medicine, Veterans General Hospital-Taipei and National Yang-Ming University School of Medicine, Taipei, Taiwan
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HSU Nai-Wei
Division of Cardiology, Department of Internal Medicine, Veterans General Hospital-Taipei and National Yang-Ming University School of Medicine, Taipei, Taiwan
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WANG Shih-Pu
Division of Cardiology, Department of Internal Medicine, Veterans General Hospital and the National Yang Ming Medical College
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WANG Shih-Pu
Division of Cardiology, Department of Internal Medicine, Veterans General Hospital-Taipei and National Yang-Ming University School of Medicine, Taipei, Taiwan
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WU Tao-Cheng
Division of Cardiology, Department of Internal Medicine, Veterans General Hospital-Taipei and National Yang-Ming University School of Medicine, Taipei, Taiwan
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CHANG Mau-Song
Division of Cardiology, Department of Internal Medicine, Veterans General Hospital and the National Yang Ming Medical College
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CHANG Mau-Song
Division of Cardiology, Department of Internal Medicine, Veterans General Hospital-Taipei and National Yang-Ming University School of Medicine, Taipei, Taiwan
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CHEN Jaw-Wen
Division of Cardiology, Department of Internal Medicine, Veterans General Hospital-Taipei and National Yang-Ming University School of Medicine, Taipei, Taiwan
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