冠状动脉造影正常伴心前区疼痛患者冠状动脉微血管功能的无创性超声多普勒评估

Noninvasive assessment of coronary microvascular function in patients with chest pain and angiographically normal coronary arteries using transthoracic Doppler echocardiography

目的 经胸多普勒超声心动图 (TTDE)与冠状动脉内多普勒 (ICD)相对照 ,分析TTDE探测冠状动脉造影正常者左前降支 (LAD)远端血流的准确性 ;分析冠状动脉造影正常者冠状动脉微血管功能的变化。方法 利用TTDE探测 3 5例冠状动脉造影正常者LAD远端的基础状态及经静脉注入腺苷后的最大血流速度 ,计算冠状动脉血流速度储备 (CFVR)、冠状动脉阻力 (CVR )和最小冠状动脉阻力指数 (CVRI)。分析比较 2 0例心前区疼痛患者 (A组 )和 15例正常人 (B组 )上述冠状动脉血流参数测值。结果 3 5例冠状动脉造影正常者TTDE所探测的基础状态血流速度 (APVb)、最大充血反应状态血流速度 (APVh)和CFVR与ICD的探测结果密切相关 (r分别为 0 .79,0 .83 ,0 .85 )。A组与B组APVb、APVh和CVR的差异均无显著性意义 (P >0 .0 5 ) ,但A组CFVR低于B组 ,而CVRI高于B组 (均P <0 .0 5 )。结论 TTDE是一项可行、可信的无创性探测CFVR的方法。冠状动脉造影正常伴心前区疼痛患者存在冠状动脉微循环功能障碍。

Objective To validate the measurement of coronary flow velocity and coronary flow velocity reserve(CFVR) by transthoracic Doppler echocardiography(TTDE) compared with invasive intracoronary Doppler flow wire technique(ICD) and to evaluate changes in coronary flow dynamics due to microvascular dysfunction in the patients with angiographically normal coronary arteries and chest pain.Methods Coronary flow velocity was measured in the distal left anterior descending artery(LAD) in 35 patients by TTDE at baseline and during intravenous adenosine infusion of 140 μg·kg -1 ·min -1 . CFVR, coronary vascular resistance(CVR) and minimal coronary vascular resistance index(CVRI) were analysed in the patients with angiographically normal coronary arteries and chest pain (group A, n =20) and compared to a control group (group B, n =15).Results Average peak velocity at baseline (APVb),average peak velocity at hyperemia (APVh) and CFVR determined from TTDE correlated closely with those from ICD measurements.CFVR was lower and CVRI was higher in group A than in group B.Conclusions Noninvasive TTDE provides reliable measurement of coronary flow velocity and CFVR in the distal LAD.Microvascular dysfunction existed in the patients with normal angiograms and chest pain.