经胸多普勒超声冠状动脉血流储备检查诊断左前降支显著狭窄  

Comparison of various transthoracic echo-Doppler parameters for measuring coronary flow reserve in patients with significant stenosis of left anterior descending coronary artery

作　　者：丁风华[1] 施仲伟[1] 胡厚达[1] 葛孝虹[1] 曹敏[1] 许燕[1] 

机构地区：[1]上海市交通大学医学院附属瑞金医院心内科,上海市200025

出　　处：《中华老年多器官疾病杂志》2008年第4期260-264,共5页Chinese Journal of Multiple Organ Diseases in the Elderly

摘　　要：目的比较经胸多普勒超声冠状动脉血流储备(CFR)指标诊断左前降支(LAD)显著狭窄的临床价值。方法连续120例怀疑冠心病的患者于冠状动脉造影(CAG)前一天进行双嘧达莫(0.56mg/kg)负荷试验,测定LAD的CFR指标,包括收缩期最大冠状动脉血流储备(SCFRpeak)、收缩期平均冠状动脉血流储备(SCFRmean)、收缩期流速时间积分储备(SCFRVTI)、舒张期最大冠状动脉血流储备(DCFRpeak)、舒张期平均冠状动脉血流储备(DCFRmean)和舒张期流速时间积分储备(DCFRVTI)。结果82例获得LAD血流频谱,按照CAG结果分为LAD显著狭窄组(A组,≥70%狭窄,n=16)和LAD非显著狭窄组(B组,<70%狭窄,n=66)。A组患者各项CFR指标均显著低于B组。ROC曲线法分析显示,DCFRmean<1.825诊断LAD显著狭窄的敏感性和特异性相对较高。结论经胸多普勒超声评价CFR有助于检出LAD显著狭窄,DCFRmean<1.825是较好的判别指标。Objective To compare the value of different coronary flow reserve （CFR） parameters by transthorracic echo-Doppler for diagnosing significant stenosis of the left anterior descending（LAD） coronary artery. Methods A total of 120 consecutive patients with suspected coronary artery disease （CAD） were studied one day before coronary angiography （CAG） by transthoracic Doppler echocardiography during dipyridamole standard-dose stress test. The CFR parameters were systolic CFR of peak velocity, systolic CFR of mean velocity （SCFRmean）, systolic CFR of velocity time integral （SCFRVTI）, diastolic CFR of peak velocity （DCFRpeak）, diastolic CFR of mean velocity （DCFRmean）, and diastolic CFR of velocity time integral. Results Blood flow of LAD can be detected and CFR parameters were calculated in 82 patients. The patients were divided into 2 groups according to angiographic results. Patients in group A （n= 16） had a significant stenotic LAD （≥70%） and those in group B （n=66） did not have. The mean value of each of the CFR parameters was significantly lower in group A than that in group B. Receiver-operating characteristic （ROC） curves showed that among the 6 parameters, DCFRmean with a cut-off point at 1. 825 had the highest sensitivity and specificity for detecting significant LAD stenosis. Conclusion Evaluation of CFR by transthoracic Doppler is helpful to detecting significant LAD stenosis and DCFRmean is the best one among the six parameters studied.

关 键 词：超声检查 多普勒 冠状动脉狭窄 血流储备分数 心肌 双嘧达莫 

分 类 号：R544.1[医药卫生—心血管疾病] R445.1[医药卫生—内科学]