经胸多普勒超声无创检测冠心病患者冠状动脉各主要分支血流储备

Noninvasive assessment of coronary artery flow reserve by transthoracic Doppler echocardiography in patients with coronary artery disease

目的 评价经胸多普勒超声心动图（TTDE）检测冠状动脉各主要分支血流储备的可行性和准确性.方法 临床疑诊冠心病拟行冠状动脉造影的439例患者,在进行冠状动脉造影前1周内进行TTDE检查,检测左前降支（LAD）、左旋支（LCx）和右冠状动脉后降支（PDA）远端的血流储备.在基础状态和持续静脉注射腺苷（140μg·kg-1·min-1）情况下分别测定其血流速度,计算血流储备（CFR）及其诊断冠状动脉狭窄的准确性.结果 439例患者中28支LAD、12支LCx和21支PDA闭塞.LAD的CFR检测成功率为96.8%（395/411）,LCx的CFR检测成功率为74.9%（320/427）,PDA的CFR检测成功率为83.0%（347/418）.以CFR≤2.0和CFR≤1.7分别作为判断冠状动脉狭窄（≥50%）和显著狭窄（≥75%）的标准,诊断LAD、LCx和PDA狭窄的灵敏度和特异度分别为81%和87%,64%和82%,79%和85%,诊断显著狭窄的灵敏度、特异度分别为86%和81%,70%和85%,81%和82%.结论 经胸多普勒超声心动图检测冠状动脉各主要分支血流储备的成功率和判断冠状动脉狭窄的准确性均较高,具有一定临床应用价值.

Objective To assess the feasibility of evaluation of coronary flow reserve （CFR） for left anterior descending （LAD）,left circumflex （LCx）,and right coronary posterior descending artery（PDA） as well as diagnostic accuracy for patency of each branches by transthoracic Doppler echocardiography （TTDE）. Methods CFR of main coronary artery branches at the distal sites were studied by TTDE with adenosine infusion （140 μg · kg-1 · min-1） in 439 consecutive patients with suspected coronary heart disease. The relations between CFR and stenosis rates of coronary bifurcations were analyzed. Results Twenty-eight of LAD,12 of LCx and 21 of PDA were occluded in 439 patients. The success rate of CFR assessment of LAD, LCx and PDA were 96.8% （395/411）, 74.9% （320/427）, 83.0% （347/418）respectively. Then CFR≤2.0 and CFR≤1.7 were chosen as the criteria of coronary stenosis （≥50 %） and severe stenosis（≥75%）. The sensitivity and specificity of detection of LAD,LCx and PDA stenosis were 81% and 87% ,64% and 82%, 79% and 85%, respectively. The sensitivity and specificity of diagnosis of LAD, LCx and PDA severe stenosis were 86% and 81%, 70% and 85%, 81% and 82%, respectively.Conclusions CFR evaluation of main coronary artery branches has high feasibility and can provide valuable information for relevant vessel patency.