冠状动脉造影正常者冠状动脉血流储备的经胸多普勒超声研究  

Comparative analysis on coronary flow velocity reserve in patients with angiographically normal coronary arteries by transthorathic Doppler echocardiography with intravascular ultrasound and intracoronary Doppler

作　　者：杨娅[1] Thomas Bartel 王新房[1] 李治安[3] Raimund Erbel 

机构地区：[1]华中科技大学同济医学院附属协和医院超声影像科,武汉现在430022 [2]Abteilunf fr kardiologie,Universit tsklinikum Essen [3]首都医科大学附属北京安贞医院超声影像科

出　　处：《中华超声影像学杂志》2003年第8期457-460,共4页Chinese Journal of Ultrasonography

摘　　要：目的　研究经胸多普勒超声心动图 (TTDE)探测冠状动脉 (冠脉 )造影正常者左前降支(LAD)远端血流的准确性 ;与冠脉内超声 (IVUS)相对照 ,分析影响冠脉造影正常者冠脉血流储备 (CFVR)的病理因素。方法　利用TTDE检测 40例冠脉造影正常者的LAD血流。CFVR为注射腺苷后的最大平均血流速率与静息状态平均血流速率的比值。结果　 37例患者成功地进行了CFVR的测量。TTDE所检测的CFVR与冠脉内多普勒 (ICD)所检测的结果密切相关 (Y =0 .65X +0 .92 ,r =0 .88,P <0 .0 0 0 1 )。合并高血压的患者CFVR减低。 34例患者行IVUS检查 ,1 7例LAD内有粥样硬化斑块形成。结论　TTDE是一项可行、可信的无创性检测CFVR的方法。冠脉造影正常者LAD内可有斑块形成 。Objective To validate the measurement of co ronary flow velocity reserve (CFVR) by transthoracic Doppler echocardiography (TTDE) with invasive intracoronary Doppler flow wire technique (ICD) and to analysis some pathological factors which influence CFVR in patients with angiographically normal coronary arteries. Methods Coronary flow velocity was measured in the distal LAD by TTDE with contrast enhancement at baseline and during intravenous adenosine infusion of 140 μg·kg -1-·min -1-. CFVR was assessed as the ratio of peak hyperemic to basal coronary flow velocity. Results CFVR was determined successfully in LAD in 37 of 40 patients with angiographically normal coronary arteries. CFVR determined from TTDE correlated closely with that from ICD measurements (Y= 0.65-X +0.92-, r= 0.88-, P< 0.000 1-). CFVR in patients with hypertension was significantly lower than that in patients without hypertension (P< 0.05-). Intravascular ultrasound (IVUS) was performed in 34 patients. Plaque formation was found in LAD by IVUS in 17 (50%) patients. No significant differences of CFVR was found between patients without plaque formation ( 3.11-± 0.49-) and with plaque formation ( 2.76-± 0.53-) (P= 0.056-). Conclusions TTDE with contrast enhancement provides reliable measurement of coronary flow velocity and CFVR in the distal LAD. The early stage of atherosclerosis could be detected by IVUS, which may be normal in angiography. CFVR is impaired in patients with hypertension compared with that in patients without hypertension.

关 键 词：冠状动脉造影正常 冠状动脉血流储备 诊断 经胸多普勒超声心动图 动脉粥样硬化 

分 类 号：R445.1[医药卫生—影像医学与核医学] R692.11[医药卫生—诊断学]