无创性冠状动脉血流储备评价冠状动脉前降支病变心肌缺血  

Evaluation of myocardial ischemia caused by left anterior descending coronary artery disease using coronary flow reserve

作　　者：朱红[1] 郑桂霞[1] 秦悦洋[1] 杨忠贤[3] 邓紫薇[1] 范洁[1] 吴丽英[2] 

机构地区：[1]黑龙江省医院超声科,哈尔滨150036 [2]黑龙江省医院心内科,哈尔滨150036 [3]黑龙江省医院心电室,哈尔滨150036

出　　处：《中华超声影像学杂志》2014年第10期852-856,共5页Chinese Journal of Ultrasonography

基　　金：2010年度黑龙江省留学回国人员科技项目择优资助基金（黑人社2011-297号）

摘　　要：目的 探讨ATP负荷经胸多普勒超声心动图法（TTDE）无创性测量冠脉血流储备（CFR）评价冠脉左前降支病变心肌缺血、预测冠脉狭窄的临床价值.方法 选取胸痛发作、已知或疑似冠心病的左前降支单支病变患者54例,在TTDE冠脉血流显像模式下,于ATP注射前、注射中和注射后分别获取左前降支远段血流频谱,测定其静息时及最大冠脉扩张时峰值流速,计算CFR.进行冠脉造影（CAG）及单光子发射计算机断层成像术（SPECT）检查.结果 ①与SPECT心肌灌注显像对照,无创性CFR法评价心肌缺血差异无明显统计学意义（P＞0.05）.CFR≤2.0评价左前降支病变相应供血区域心肌缺血的敏感性为93.3％,特异性为89.7％.②冠脉狭窄与CFR呈负相关（P＜0.001）,随着狭窄程度加重,CFR逐渐减低.绘制ROC曲线,以CFR≤1.60为截断值预测冠脉显著狭窄的敏感性和特异性分别为92.3％和73.3％.结论 ATP负荷TTDE法CFR是评价冠心病心肌缺血的敏感指标并可以预测冠脉显著狭窄;CFR与CAG联合对稳定型冠心病治疗方案的选择具有重要临床价值.Objective To explore the value of coronary flow reserve（CFR） evaluating myocardial ischemia measured by adenosine triphosphate （ATP） stress transthoracic Doppler echocardiography （TTDE）,and the feasibility of CFR to predict coronary stenosis.Methods Fifty-four patients suffering chest pain with known or suspected coronary artery disease were performed ATP stress TTDE to measure resting and maximum expansion coronary blood flow velocity and calculate CFR.all patients were performed by coronary angiography （CAG） and single-photon emission computed tomography （SPECT） myocardial perfusion imaging.Results ① To evaluate myocardial ischemia,there was not statistical significant difference between non-invasive CFR and SPECT myocardial perfusion imaging（P 〉0.05）.CFR≤2.0 was the best cutoff value for evaluating myocardial ischemia which yielded a sensitivity of 93.3 % and specificity of 89.7%.②Coronary artery stenosis was negatively correlated with CFR （P 〈0.001）.ROC curve analysis demonstrated that CFR≤ 1.60 yielded a sensitivity of 92.3% and specificity of 73.3% to predict coronary stenosis significantly.Conclusions CFR measured by ATP stress TTDE can evaluate myocardial ischemia of coronary artery disease and predict LAD significant stenosis before CAG.Using CFR and CAG has important clinical value for choosing treatment of stable coronary artery disease.

关 键 词：超声心动描记术 压力 血流储备分数 心肌 心肌缺血 冠状动脉狭窄 腺苷三磷酸 

分 类 号：R541.4[医药卫生—心血管疾病] R445.1[医药卫生—内科学]