STUDY OBJECTIVE:The aim was to clarify the characteristics of the phasic blood velocity pattern and their possible causes in left ventricular hypertrophy secondary to systemic hypertension. DESIGN:Measurements of blood velocities in the left anterior descending coronary artery were made with a 20 MHz Doppler catheter with a top mounted annular crystal. All patients had normal coronary arteriograms. PATIENTS:23 hypertensive patients [systolic/diastolic pressure: 181(SD 15)/100(4) mm Hg)] with left ventricular hypertrophy, and 13 atypical chest pain patients without left ventricular hypertrophy or any abnormal haemodynamic findings (normal controls) entered the study. MEASUREMENTS AND MAIN RESULTS:The left anterior descending coronary artery blood velocity waveform in pressure overloaded left ventricular hypertrophy was characterised by delayed early diastolic inflow. The diastolic rise time of coronary flow (TDR), ie, the time from the beginning of diastole to peak velocity, was higher in patients with hypertensive left ventricular hypertrophy than in normal controls, at 145(56) v 66(15) ms, p less than 0.001. In patients with hypertensive left ventricular hypertrophy, TDR correlated well with the degree of hypertrophy (r = 0.83, p less than 0.01) and also with peak left ventricular systolic pressure (r = 0.62, p less than 0.01). The coronary flow reserve, calculated from the ratio of the diastolic mean velocity after intracoronary injection of papaverine to the resting flow velocity, decreased with prolongation of TDR (r = 0.58, p less than 0.02). CONCLUSIONS:(1) Impairment of early diastolic coronary arterial inflow is the most remarkable characteristic in pressure overloaded left ventricular hypertrophy; (2) preceding systolic vascular compression and impaired left ventricular relaxation correlate with the delayed early diastolic inflow; (3) the delayed inflow is an important possible cause of the decreased coronary flow reserve in the hypertensive left ventricular hypertrophy.

译文

目的:阐明系统性高血压继发于左心室肥厚的阶段性血流速度特征及其可能原因。
设计:使用20 MHz多普勒导管和顶部安装的环形晶体对冠状动脉左前降支中的血流速度进行测量。所有患者的冠状动脉造影检查均正常。
患者:23例左室肥厚的高血压患者[收缩压/舒张压:181(SD 15)/ 100(4)mm Hg),13例非典型性胸痛患者,无左室肥厚或任何血流动力学异常(正常对照)研究。
测量和主要结果:压力超负荷左心室肥厚中左前降支冠状动脉血流波形的特征是早期舒张期迟发流入。高血压左心室肥厚患者的冠状动脉血流舒张上升时间(TDR),即从舒张开始到达到峰值速度的时间,比正常对照组长,为145(56)v 66(15)ms, p小于0.001。在患有高血压左心室肥大的患者中,TDR与肥大程度(r = 0.83,p小于0.01)以及峰值左心室收缩压(r = 0.62,p小于0.01)密切相关。由冠状动脉内注射罂粟碱后舒张平均速度与静息流速之比计算得出的冠状动脉血流储备随TDR延长而降低(r = 0.58,p小于0.02)。
结论:(1)左心室肥厚是舒张早期冠状动脉血流减少的最显着特征。 (2)收缩期前血管收缩和左心室舒张受损与舒张早期流入延迟有关。 (3)延迟流入是高血压左心室肥厚中冠状动脉血流储备减少的重要可能原因。

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