ドプラーフローワイヤーとアデノシン三リン酸二ナトリウム（ATP）冠動脈内投与による冠予備能評価法—殊に至適ATP量に関する検討

Assessment of Coronary Flow Reserve Using the Doppler Flowire and Intracoronary Injection of Adenosine Triphosphate Disodium (ATP):Assessment of optimal dosages

　Doppler flowireによるcoronary flow reserve測定に要するアデノシン三リン酸二ナトリウム（ATP）の至適用量を検討するために，冠動脈造影にて正常冠動脈を呈した11症例の主要冠動脈の近位部にDoppler fiowireを挿入しcoronary flow reserveを検討した．左前下行枝，左回旋枝ではATPを10μg,20μg,30μg投与し，ついでニトログリセリン（NTG）200μg，造影剤7mlおよび塩酸papaverine 6mgを順に冠動脈内に投与した．また，右冠動脈ではATP（5μg,10μg,15μg），NTG 200μg，造影剤3.5mlおよび塩酸papaverine 3mgを投与した．その結果，左前下行枝ではATP 10μgに比較し，20μg,30μgおよび塩酸papaverine投与時のcoronary flow reserveはそれぞれ有意に大であり，ATP 20μg,30　μgと塩酸papaverine投与ではcoronary flow reserveは同程度であった．また，左回旋枝では左前下行枝と同様であり，右冠動脈ではATP 5μgに比べ，10μg,15μg,NTG 200μg，塩酸papaverine投与時のcoronary flow reserveは有意に大で，これらによるcoronary flow reserve値には有意差はなかった．いずれの主要冠動脈枝においてもcoronary flow reserve値の最大値は安静時の値の約3〜4倍に達していた．Coronaryflow reserveを検討する際のATPの用量は，左冠動脈は20μg，右冠動脈は10μgで十分であることが示唆された．

To investigate an optimal dosage of adenosine tri-phosphate disodium (ATP) for the assessment of coro-nary flow reserve (CFR) using Doppler flowire, we measured CFR by an intracoronary injection of follow-ing agents; ATP of 10μg, 20μg, 30μg, nitroglycerin (NTG) of 200μg, dye (Iovesol, 74 %) of 7ml, and papaverine of 6mg for left coronary artery (left descending artery and left circumflex arerty) as well as ATP of 5μg, 10μg, l5μg, nitroglycerin (NTG) of 200μg, dye (Iovesol, 74 %) of 3.5ml, and papaverine of 3mg for right coronary artery. In left descending artery and left circumflex artery, CFR values by ATP of 20μg and 30μg were significantly greater than that by ATP of lOμg. These CFR values were not significantly different from the measure by papaveine of 6mg. Also, in right coronary artery, CFR values by ATP of 10μg, 15μg and NTG of 200μg were significantly greater than that by ATP of 5μg. Again, these CFR value were not significantly different from the measure by papaverine of 3mg. The optimal dosages of ATP were suggested to be 20μg for left coronary artery and 10ug for right coronary artery, respectively.