胸痛患者冠状动脉血流储备的超声研究  

Evaluation of coronary flow reserve in patients with left coronary artery disease and with syndrome X by transesophageal echocardiography

作　　者：张薇[1] 白晨[1] 张运[1] 李继福[1] 李贵双[1] 葛志明[1] 季小平[1] 

机构地区：[1]山东大学齐鲁医院心内科,济南250012

出　　处：《临床心血管病杂志》2002年第1期24-26,共3页Journal of Clinical Cardiology

基　　金：山东省科委资助项目 (No .96 30 0 0 0 5 7)

摘　　要：目的 :应用多平面经食管多普勒超声心动图 (TEE)潘生丁负荷试验 ,探讨胸痛患者的冠状动脉 (冠脉 )循环特点及血流储备 (CFR)功能。方法 :将受试者分为 4组 :冠脉前降支重度狭窄 (A组 ) 10例 ,轻度狭窄 (B组 ) 6例 ,X综合征 (C组 ) 7例 ,冠脉造影正常 (对照组 ) 15例。应用TEE测定冠脉前降支血流频谱 ,以基础状态下(R)和潘生丁负荷后 (D)冠脉舒张期最大流速比值 (D/RPDV)为CFR的指标。结果 :与对照组比较 ,其他 3组基础状态时冠脉血流速度差异无显著性意义 ;CFR明显减低 ,以A组最为明显〔(1.5 5± 4 3)∶(3.4 3± 0 .6 2 )cm/s,P<0 .0 0 1〕 ,狭窄程度与D/RPDV高度相关 (r =0 .83,P <0 .0 0 1) ;B组与C组比较 ,CFR减低程度一致〔(2 .6 2± 0 .71)∶(2 .19± 0 .36 )cm/s,P >0 .0 5 )〕。结论 :CFR反映了冠脉狭窄时冠脉的血流动力学改变 ,可用于判断冠脉狭窄的程度 ;Objective: To evaluate coronary flow reserve (CFR) in patients with left coronary artery disease and with syndrome X. Method:Transesophageal echocardiography were performed in 15 control subjects, 10 patients with >70% left anterior descending coronary artery (LAD) stenosis, 6 patients with 30%～60% LAD stenosis and 7 patients with syndrome X. The peak diastolic coronary flow velocity (PVD) was recorded in the proximal part of the left descending artery with use of pulsed Doppler guided by color flow imaging before and after an intravenous dipyridamole infusion ( 0.56 mg/kg in 4 min ). CFR was calculated as the ratio of the dipyridamole to rest PVD (D/R PDV).Result:Doppler parameters were not significantly different in all groups at baseline. Increase in PVD was significantly lower in patients with coronary artery disease and syndrome X compared with control patients after dipyridamole administration. D/R PDV was ( 1.55 ± 0.43 ) cm/s in patients with severe coronary artery disease, ( 2.62 ± 0.71 ) cm/s in those with less severe disease and ( 2.19 ± 0.36 ) cm/s in patients with syndrome X, which was significantly lower than D/R PDV of ( 3.43 ± 0.62 ) cm/s found in control group (P< 0.05 ～ 0.001 ). Furthermore, D/R PDV was lower in patients with severe coronary artery disease than that in patients with less severe disease and with syndrome X (P< 0.05 ～ 0.01 ). As a result D/R PDV was corelated with coronary artery stenosis (r= 0.83 ,P< 0.001 ). Conclusion:CFR calculated by TEE is a feasible and reliable method. CFR can be used for noninvasive evaluation of patients with syndrome X and patients with severe left coronary artery disease.

关 键 词：经食管超声心动图 冠状动脉血流储备 冠状动脉疾病 X综合征 

分 类 号：R541.4[医药卫生—心血管疾病]