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Analyse der Unterarmzirkulation — Ein Surrogat für die Diagnostik koronarer Durchblutungsstörungen?

Analysis of forearm blood flow — A surrogate for the diagnosis of coronary atherosclerosis?

  • Koronare Atherosklerose — Funktionelle Konsequenzen
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Zusammenfassung

Dem Gefäßendothel kommt eine zentrale Rolle in der Regulation des arteriellen Gefäßtonus und bei der Steuerung der lokalen Hämostase zu. Auch ist das Gefäßendothel regulierend an Proliferationsprozessen der Gefäßwand beteiligt. Beim Vorliegen von Risikofaktoren für die koronare Herzerkrankung bzw. beim Vorliegen einer klinisch manifesten kardialen Durchblutungsstörung ist die endotheliale Gefäßregulation beeinträchtigt. Eine endothelvermittelte Gefäß-dilatation läßt sich durch die intraarterielle Gabe von Acetylcholin erzielen.

Atherosklerotische Veränderungen der Koronararterien verlaufen parallel zur Atherosklerose der Arteria brachialis; die endotheliale Dysfunktion der Koronararterien ist mit der endothelvermittelten Gefäßregulationsstörung der Arteria brachialis vergleichbar.

Eine nichtinvasive Untersuchung der endothelvermittelten Gefäßregulation ist mittels Ultraschalluntersuchung der Arteria brachialis möglich. Aufgrund methodischer Schwierigkeiten resultiert jedoch eine große Streubreite der Einzelwerte.

Mittels venöser Unterarmverschlußplethysmographie ist semiinvasiv die Messung des Unterarmblutflusses möglich. Die endothelvermittelte Zunahme des Unterarmblutflusses wird durch die Infusion von Acetylcholin in die Arteria brachialis erreicht. Die Infusion von Natriumnitroprussid bewirkt eine endothelunabhängige Zunahme des Unterarmblutflusses und gilt als Maß der NO-vermittelten vasodilatatorischen Kapazität.

Unter der Voraussetzung eines generalisierten Krankheitsprozesses der Atherosklerose sind die Ergebnisse der Messung des Unterarmblutflusses mittels venöser Verschlußplethysmographie auf den Zustand der Koronarien übertragbar. Der letztendliche Beweis der positiven Korrelation zwischen dem Grad der Einschränkung des durch die venöse Unterarmverschlußplethysmographie gemessenen Unterarmflusses und dem Ausprägungsgrad der Koronararteriensklerose, wie er für die Ultraschalldiagnostik einer Gefäßregulationsstörung der Arteria brachialis erbracht wurde, steht aber noch aus.

Summary

The vascular endothelium plays a central role in the regulation of the arterial tone and in the control of the local hemostasis. It is also involved in the regulation of proliferation processes of the vascular wall. The presence of risk factors for coronary artery disease and/or manifest atherosclerotic lesions are associated with an impairment of endothelium-dependent vaso-regulation.

Since the assessment of coronary vascular reactivity requires an invasive approach, it would be desirable to non- or semiinvasively evaluate blood flow regulation and its impairment by atherosclerotic processes. Indeed, endothelial dysfunction of the coronary arteries parallels endothelium-related impairment of vasoreactivity of the brachial artery. Analysis of flow-dependent dilatation of the brachial artery by means of ultrasound represents a non-invasive diagnostic tool to assess endothelium-mediated vasomotion.

By means of venous strain gauge forearm occlusion plethys-mography, it is possible to measure the blood flow in a semi-invasive way. The endothelium-mediated forearm blood flow response is obtained by the infusion of acetylcholine into the brachial artery, whereas infusion of sodium-nitroprusside provides information about the endothelium-independent vasodilator capacity of the forearm resistance vasculature.

Assuming that the atherosclerotic process is a generalized disease, the assessment of the forearm blood flow by venous strain gauge occlusion plethysmography may provide some information applicable to the coronary circulation. However, the proof of a positive correlation between the degree of the impaired forearm blood flow responses measured by occlusion plethysmography and the extent of coronary atherosclerosis and its disturbed vasoregulation remains to be established.

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  1. Medizinische Klinik IV, Abteilung für Kardiologie, Klinikum der Universität, Theodor-Stern-Kai 7, D-60590, Frankfurt/Main

    Gunter Rosenberger & Stephan Fichtlscherer

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Rosenberger, G., Fichtlscherer, S. Analyse der Unterarmzirkulation — Ein Surrogat für die Diagnostik koronarer Durchblutungsstörungen?. Herz 23, 130–134 (1998). https://doi.org/10.1007/BF03044543

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