冠状动脉内多普勒导丝评价主动脉瓣狭窄对冠状动脉血流的影响

Evaluation of coronary flow in patients with aortic stenosis by Doppler guide wire

目的应用冠状动脉内多普勒导丝评价主动脉瓣狭窄对冠状动脉血流的影响。方法选取慢性重度的主动脉瓣狭窄患者13例,先行冠状动脉造影检查,排除冠心病,再行冠状动脉内多普勒检查,测定前降支中远端的平均峰值流速(APV),舒张收缩流速比值(DSVR),冠状动脉血流储备(CFR)等,并测定左室舒张末压力(LVEDP),用10例正常数据作对照。结果与正常对照组相比,主动脉瓣狭窄时,冠状动脉血流LVEDP升高[(18.6±9.5)mmHgvs(7.9±5.5)mm-Hg,P<0.05];APV降低[(15.8±9.5)cm/svs(24.8±14.6)cm/s,P<0.05];DSVR无变化(2.4±1.9vs2.6±1.7,P>0.05);CFR升高(4.8±2.7vs3.5±2.2,P<0.05);前降支中段内径变化不大[(3.7±1.5)mmvs(3.5±1.4)mm,P>0.05]。结论慢性重度主动脉瓣狭窄对冠状动脉血流有显著影响,表现为基础状态时APV降低,DSVR无变化和CFR升高,并使左室舒张功能减低。APV减低可能是冠状动脉造影正常的主动脉瓣狭窄患者心绞痛的主要机制。

Objective To evaluate coronary flow reserve （CFR） in patients with severe aortic stenosis （AS） by intracoronary Doppler guide wire. Methods Intracoronary Doppler guide wire were performed in 10 control subjects and 13 patients with AS. The average peak velocity （APV）, diastolic systolic velocity ratio （DSVR） and coronary flow reserve （CFR） were recorded in the middle or proximal part of the left anterior descending coronary artery （LAD）. Left ventricular end diastolic pressure （LVEDP） was also measured. Results Compared with control subjects, in patients with AS, LVEDP increased prominently （18.6±9.5 mmHg vs 7.9±5.5 mmHg, P〉0.05）, APV decreased prominently （15.8±9.5 cm/s vs 24.8±14. 6cm/s, P〈O. 05）, DSVR had no change （2. 4±1.9 vs 2. 6±1.7, P〉O. 05）, but CFR increased prominently （4.8±2.7 vs 3.5±2.2, P〈0.05） ; the internal diameter of LAD did not change obviously （3.7±1.5 mm vs 3.5±1.4 mm, P〉 0.05）. Conclusion The coronary flow and APV was impaired in patients with chronic severe aortic stenosis. Abnormal low baseline coronary flow velocity caused by an increase in myocardial oxygen demand is the underline mechanism. The mecha- nism of angina peetoris in patients with AS and normal epicardia coronary arteries may be a reduction of the APV.