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英文誌(2004-)

Journal of Medical Ultrasonics

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2000 - Vol.27

Vol.27 No.03

Original Article(原著)

(0209 - 0217)

インスリン抵抗性患者における冠微小循環障害の評価: 経胸壁ドプラ心エコー図法を用いた冠予備能による検討

Noninvasive Assessment of Coronary Microvascular Dysfunction in Patients with Insulin Resistance by Coronary Flow Reserve Using Transthoracic Doppler Echocardiography

平尾 健一1, 水重 克文1, 近藤 功1, 高木 雄一郎1, 辻 哲平1, 千田 彰一2, 松尾 裕英1

Kenichi HIRAO1, Katsufumi MIZUSHIGE1, Isao KONDO1, Yuichiro TAKAGI1, Teppei TSUJI1, Shoichi SENDA2, Hirohide MATSUO1

1香川医科大学第2内科, 2香川医科大学総合診療部

1Second Department of Internal Medicine, Kagawa Medical University, 2Department of Integrated Medicine, Kagawa Medical University

キーワード : Coronary flow reserve, Insulin resistance, Microvascular dysfunction, Obesity, Transthoracic Doppler echocardiography

Background. Coronary flow reserve (CFR) has been considered to be an important indicator of coronary microvascular function in the absence of coronary artery stenosis. Although the reduction of CFR has been described in patients with diabetes mellitus, there are few data from patients with insulin resistance. Recent technological advances in transthoracic Doppler echocardiography (TTDE) have made noninvasive measurement of coronary flow velocity in the distal portion of the left anterior descending artery (LAD) possible.
Objectives. We attempt to use TTDE to examine coronary microvascular function in patients with insulin resistance.
Methods. The study population consisted of 6 patients with normal glucose tolerance (NGT), 14 with insulin resistance and Body Mass Index values in excess of 26.4 (IR), and 14 with non-insulin-dependent diabetes mellitus (DM). Cases of IR were assorted into two subgroups: those with complications (IR-C) and those without complications (IR-nC). No patient showed evidence of myocardial infarction, angina pectoris, cardiomyopathy, or significant ST-T change during the treadmill exercise stress test or dobutamine stress echocardiography. Coronary flow velocity at the distal LAD was recorded using a digital TTDE system with a high frequency (7 MHz) transducer at rest and during hyperemia induced by intravenous infusion of adenosine (0. 14 mg/kg per minute) under the guidance of color Doppler flow mapping.
Results. Adequate spectral Doppler recordings of coronary flow were obtained in 29 (85%) of 34 subjects. CFR was defined as the ratio of peak diastolic coronary flow velocity at hyperemia to the baseline value. CFRs in IR-C were similar to those in DM (2.0±0.2 vs 2.2±0.4, n.s.) and lower than those in NGT (3.5±0.6)(p Conclusions. Insulin resistance was not an important risk factor in the reduction of CFR. Also, TTDE was a feasible method for noninvasive assessment of CFR in patients with IR and DM.