主动脉瓣反流对冠状动脉循环的影响  

Evaluation of coronary flow reserve in patients with aortic regurgitation by transesophageal echocardiography

作　　者：张薇[1] 白晨[1] 张运[1] 张学义[1] 季晓平[1] 葛志明[1] 魏来临[1] 钟明[1] 

机构地区：[1]山东大学齐鲁医院心内科,济南250012

出　　处：《中华超声影像学杂志》2002年第9期517-520,共4页Chinese Journal of Ultrasonography

基　　金：山东省科委资助项目 (9630 0 0 0 57)

摘　　要：目的　应用多平面经食管超声心动图 (TEE)双嘧达莫负荷试验 ,探讨主动脉瓣反流患者的冠状动脉循环特点及血流储备 (CFR)功能。方法　对照组 15例 ,主动脉瓣反流组 18例。应用TEE测量静脉注射双嘧达莫前后冠状动脉左前降支内径和血流频谱 ,以药物负荷 (D)与基础状态下 (R )冠状动脉舒张期峰值流速 (PDV)比 (D/RPDV )为CFR的代表指标。结果　与对照组比较 ,主动脉瓣反流组基础状态下冠状动脉内径扩大 ,流速增加 ,D/RPDV减低 ( 2 .36± 0 .74vs 3.43± 0 .6 2 ,P <0 .0 1) ;PDV与左室舒张末期压力、收缩压和心率正相关 (P <0 .0 5～ 0 .0 0 1) ;与左室射血分数负相关 (P <0 .0 5 )。结论　主动脉瓣反流对冠状动脉循环的影响主要为基础状态下冠状动脉内径扩大、血流速度增加及CFR减低 ;CFR减低可能是冠状动脉造影正常的主动脉瓣反流患者心绞痛的主要机制。Objective To evaluate coronary flow reserve (CFR) in patients with aortic regurgitation(AR).Methods Transesophageal echocardiography were performed in 15 control subjects and 18 patients with AR. The peak diastolic coronary flow velocity (PDV) was recorded in the proximal part of the left anterior descending coronary artery (LAD) 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 defined as dipyridamole (D)/rest (R) ratio of flow velocity (D/R PDV). Results At baseline LAD diameter was lager [( 3.39± 0.69)mm vs ( 3.07± 0.67)mm, P< 0.05], and PDV was higher [( 57.13± 30.32)cm/s vs ( 35.80± 9.40)cm/s, P< 0.05] in patients with AR compared with control subjects. After dipyridamole administration, all measurements of coronary blood flow patterns were no significant difference in patients with AR and control subjects. CFR was significantly decreased in patients with AR than that in control subjects (D/R PDV: 2.36± 0.74 vs 3.43± 0.71, P< 0.001).Conclusions The CFR was impaired in patients with aortic regurgitation. Abnormal high baseline coronary flow velocity caused by an increase in myocardial oxygen demand is the underline mechanism. The mechanism of angina pectoris in patients with AR and normal epicardia coronary artetries may be a reduction of the CFR.

关 键 词：主动脉瓣反流 冠状动脉循环 超声心动描记术 主动脉瓣关闭不全 

分 类 号：R540.45[医药卫生—心血管疾病]