冠脉内多普勒血流速度描记评价冠脉血流储备

Evaluation of coronary flow feserve by intracoronary Doppler flowire

目的 评价冠脉内多普勒血流速度描记在冠脉造影正常、中度狭窄和重度狭窄患者定量冠脉血流储备的价值。方法 采用美国Ｃａｒｄｉｏｍ ｅｔｒｉｃｓ ＦｌｏＭａｐ Ⅱ超声诊断仪和直径０．０１４英寸或０．０１８英寸血流速度描记钢丝， 对５５例行冠脉造影的患者分四组研究： 甲组为７例冠脉造影正常且无冠脉微循环病变基础的患者； 乙组为２０例冠脉造影正常但有冠脉微循环病变基础的患者； 丙组为１２例冠脉造影示中度狭窄（３０％ ～７０％ ）的患者； 丁组为１６例冠脉造影示重度狭窄（＞ ７０％ ）的患者。结果 乙组冠脉远端基础状态下平均峰速（ＡＰＶ）较甲组增高（Ｐ＜ ０．０５）， 但远端峰值ＡＰＶ的差别无显著意义（Ｐ＞ ０．０５）， 故乙组冠脉血流储备（ＣＦＲ）明显低于甲组（Ｐ＜ ０．０００５）。以ＣＦＲ＞ ２．０为标准判断ＣＦＲ正常， 发现乙组３７支冠脉（７７％ ）ＣＦＲ正常， １１支冠脉（２３％ ）ＣＦＲ异常。乙组ＣＦＲ异常的１１支冠脉中， ７支（６３．６４％ ）在左室肥厚者。丙组ＣＦＲ较甲组小［（２．０２±０．４８） ｖｓ（３．１９±０．６５），Ｐ＜ ０．００１］。丁组ＣＦＲ与甲组间的差别更大［（１．５０±１．０１） ｖｓ （３．１９±０．６５），

Objective\ To evaluate the intracoronary Doppler flowire in coronary arteries with or without stenosis. Methods\ 55 patients with coronary angiography were studied by Cardiometrics FloMap Ⅱultrasound instrument and 0.014 inch flowire. The patients were divided into four groups. Group A consisted of 7 patients without underlying diseases of coronary microvascular lesions and with normal angiography. Group B consisted of 20 patients with underlying diseases of coronary microvascular lesions including hypertension 16, hypertension combined with diabetes 2, and cardiomyopathy 2. Group C consisted of 12 patients with moderate stenosis (30%~70% diameter narrowing in angiography). Group D consisted of 16 patients with severe stenosis (>70% diameter narrowing in angiography). The measurements included distal baseline average peak velocity (APV), hyperemic APV and flow reserve (CFR). Results\ The baseline APV in group B was higher than group A [(19.05±6.46) vs (15.39±6.29), P<0.05], so CFR in group B was significantly lower than group A [(2.48±0.69) vs (3.19±0.65), P<0.0005]. To assess the difference of APV between patients with normal and abnormal CFR in group B, CFR>2.0 was determined as normal CFR criteria according to group A. CFR was normal in 37 arteries (77%), and 11 arteries (23%) was abnormal. Among the 11 abnormal CFR arteries, 7 arteries (63.64%) with left ventricular hypertrophy. Compared with group A, CFR in distal arteries had significantly decreased in group C [(2.02±0.48) vs (3.19±0.65), P<0.001], CFR had further deterioration in group D [(1.50±1.01) vs (3.19±0.65), P<0.005]. Significantly lower hyperemic APV was also observed in group D [(21.69±16.28) vs (46.32±14.08), P<0.001]. Conclusions\ Although the coronary angiography was normal in patients with underlying diseases of coronary microvascular lesions, 23% arteries had abnormal CFR. Compared with normal coronary control, CFR was further decreased with increassing severity of stenosed coronary arteries.