经胸超声冠状动脉血流显像技术评价支架术前后冠状动脉血流储备的初步临床应用  

Initial exploration on noninvasive assessment of coronary flow reserve using transthoracic coronary flow imaging before and after successful coronary stent implantation

作　　者：谢明星[1] 王新房[1] 王祥[2] 吕清[1] 杨娅[1] 黄润青[1] 卢晓芳[1] 杨亚利[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院超声科,武汉430022 [2]华中科技大学同济医学院附属协和医院心导管室,武汉430022

出　　处：《中华超声影像学杂志》2003年第6期325-328,共4页Chinese Journal of Ultrasonography

摘　　要：目的　探讨经胸超声冠状动脉血流显像技术评估冠心病支架术前、后冠状动脉血流储备(CFR)的价值。方法　 2 8例冠状动脉前降支狭窄的冠心病患者对狭窄的冠状动脉行经皮冠状动脉内成形术 (PTCA)后各置入 1枚支架。分别于术前、术后 72h内 ,采用经胸超声多普勒冠状动脉血流显像技术检测左冠状动脉前降支狭窄远端静息舒张期血流峰速 (r Vd)、注射潘生丁时最大舒张期血流峰速 (d Vd)及CFR。结果　 2 8例患者行支架术均获成功 ,狭窄率由术前 84.2 %± 8.6%降至术后 5 .4%± 0 .8% ,(P <0 .0 5 ) 。 2 8例患者共 40支病变血管中 ,3 4支狭窄冠状动脉远端检测到多普勒频谱 (检出率 85 % )。支架术后r Vd较术前r Vd有增加趋势 ,但差异无显著性意义 ( P >0 .0 5 ) ;术后静脉注射潘生丁后最大d Vd及CFR均较术前明显增加 [( 0 .94± 0 .2 1)m/s对 ( 0 .5 1± 0 .18)m /s ,3 .2 1± 1.2 1对 1.89± 0 .40 ,均P <0 .0 5 ]。结论经胸超声多普勒冠状动脉血流显像技术结合潘生丁试验是一种简便、易行、无创性评价冠心病患者冠状动脉介入治疗前后血流储备变化的新方法。Objective To estimate the value of transthoracic coronary flow Doppler imaging to detect coronary flow velocity changes in patients undergoing coronary angioplasty and stenting and to assess coronary flow reserve(CFR) of the procedure. Methods Twenty eight patients with coronary vessel disease undergoing stent implantion were studied with transthoracic pulsed Doppler guided by color flow imaging to record coronary diastolic peak velocicy at rest (r Vd) and <72 hours after the interventional procedure. Results Coronary flow velocity Doppler signals were successfully obtained in 34/40 narrowing coronary arteries (85%) of 28 patients. Narrowing percent in diameter for 28 LAD decreased from 84.2 % ± 8.6 % before to 5.4 %± 0.8 % after stenting (P< 0.05 ). Both maximal d Vd and CFR significantly increased after stenting [( 0.94 ± 0.21 )m/s vs ( 0.52 ± 0.18 )m/s, 3.21 ± 1.21 vs 1.89 ± 0.40 , P< 0.05 ].After stenting, r Vd tended to increase [( 0.36 ± 0.18 )m/s vs ( 0.24 ± 0.09 )m/s, P> 0.05 ]. Impaired CFR after successful stenting (25%,7/28) was related to an increased resting flow velocity. Patients with an increase of CFR after stenting were characterized by an unaltered resting flow velocity and an increased dipyridamole induced maximal flow velocity. Conclusions In patients with coronary artery stenosis, transthoracic coronary flow imaging combined with intravenous dipyridamole shows improvement in CFR after successful stent implantation. This new method may be a feasible and promising technique for assessing CFR with a real noninvasive approach.

关 键 词：经胸超声冠状动脉血流显像 冠状动脉血流储备 冠心病 经皮冠状动脉内血管成形术 支架置入术 

分 类 号：R445.1[医药卫生—影像医学与核医学] R541.4[医药卫生—诊断学]