arthyperАртериальная гипертензия"Arterial’naya Gipertenziya" ("Arterial Hypertension")1607-419X2411-8524Antihypertensive League10.18705/1607-419X-2005-11-3-185-187arthyper-1020Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESСостояние коронарной гемодинамики при гипертрофии миокарда левого желудочка по результатам позитронной эмиссионной томографии с13N-аммониемCoronary hemodynamics in left ventricular hypertrophy, as evidenced by13N-ammonium positron emission tomographyРыжковаД. В.RyzhkovaD. V.noemail@neicon.ruКрасильниковаЛ. А.KrasilnikovaL. A.noemail@neicon.ruНифонтовЕ. М.NifontovYe. M.noemail@neicon.ruТютинЛ. А.TyutinL. A.noemail@neicon.ruДемченкоЕ. А.DemchenkoE. A.noemail@neicon.ruЦНИРРИ МЗ и СР РФRussian FederationПСПбГМУ им. акад. И.П. ПавловаRussian Federation200528062005113185187Copyright © Рыжкова Д.В., Красильникова Л.А., Нифонтов Е.М., Тютин Л.А., Демченко Е.А., 20052005Рыжкова Д.В., Красильникова Л.А., Нифонтов Е.М., Тютин Л.А., Демченко Е.А.Ryzhkova D.V., Krasilnikova L.A., Nifontov Y.M., Tyutin L.A., Demchenko E.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://htn.almazovcentre.ru/jour/article/view/1020

У пациентов с гипертрофией левого желудочка (ГЛЖ) изучали коронарную гемодинамику методом позитронной эмиссионной томографии (ПЭТ) с13N-аммонием. Нами было обследовано 38 человек в возрасте 53,22±9,57 года с ГЛЖ на фоне гипертонической болезни. Контрольную группу составили 15 человек без указаний на заболевания сердечно-сосудистой системы и анамнезе. Структурно-функциональные параметры левого желудочка определяли методом эхокардиографии. Миокардиальный кровоток (МК) оценивали на фоне фармакологического теста с дипиридамолом методом ПЭТ. Рассчитывали коронарный резерв (КР) и сосудистое сопротивление коронарных артерий (ССКА). Средние значения МК в покос у больных с ГЛЖ и в контрольной группе достоверно не различались (73,3±12,8 мл/мин на 100 г ткани против 73,4±16,6 мл/мин на 100 г ткани, различия недостоверны). При проведении теста с дипиридамолом значения МК и КР были достоверно ниже в группе пациентов с ГЛЖ (140,4±35,1 мл/мин на 100 г ткани против 219,86±69,2 мл/мин на 100 г ткани (p<0,05) и 1,94±0,62 против 2,95±0,41(р<0,05) соответственно). ССКА на фоне вазодилатации было существенно ниже в контрольной группе (0,54±0,16 против 0,89±0,24; р<0,05). Корреляционной зависимости между параметрами коронарной динамики и индексом массы миокарда левого желудочка (ИММЛЖ) выявлено не было. КР при концентрическом типе ГЛЖ был существенно ниже, чем при эксцентрическом типе (1,77±0,44 против 2,11±0,51; р<0,05). У всех пациентов с концентрическим типом ГЛЖ отмечалось нарушение диастолической функции левого желудочка (ЛЖ), тогда как при эксцентрическом гипе ГЛЖ диастолическая дисфункция наблюдалась только и одном случае. При ГЛЖ МК в состоянии покоя практически не отличается от нормальных значений, однако ответ коронарного русла па фармакологическую вазодилатацию дипиридамолом существенно снижен. Снижение коронарного резерва в большей степени выражено при концентрическом типе гипертрофии и зависит от состояния диастолической функции ЛЖ.

In patients with left ventricular hypertrophv (LVH), coronary hemodynamics was studied by13N-ammonium positron emission tomography (PET). We examined 38 patients aged 53,22±9,57 years, who had LVH in the presence of hypertensive disease. A control group comprised 15 individuals without a history of cardiovascular diseases The structural and functional parameters on the left ventricle were determined by echocadiography. Myocardial blood flow (МBР) was evaluated at rest and during a dipyridamole test, by using PET. The coronагу reserve (CR) and resistanсe were calculated. In the patients with LVH and in the controls, the mean resting values of MBF did not differ significantly (73,3±12,8 versus 73,4±16,6 ml/min per 100 g of tissue, the differences wen insignificant). During the dipyridamole test, the values of MBF and CR were significantly lower in the patients with LVH (140,4±35,1 versus 219,86±69,2 ml/min per 100 g of tissue (p<0,5) and (1,94±0,62 versus 2,95±0,41 (p<0,05), respectively). In the presence of vasodilatation, coronary resistance was substantially less in the control group (0,54±0,16 versus 0,89±0,24; p<0,05). There was no correlation between the coronary hemodynamic parameters and the left ventricular myocardial mass index. CR was substantially less in the concentric type of LVH than that in the eccentric type (1,77±0,44 versus 2,11±0,51; p<0,05). All patients with concentric LVH showed impaired left ventricular diastolic function (LVDF) whereas the latter was observed only in case in the eccentric type. In LVH, resting МBF did not virtually differ from the normal values; however, the coronary bed responded to dipyridamole-induced vasodilatation to a substantially lesser degree. The decrease in CR was largely marked in concentric hypertrophy and associated with LVDF.

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The authors declare that there are no conflicts of interest present.