PTCA前后应用多普勒导丝测定冠状动脉血流速度及储备功能的意义

Significance of measuring coronary blood velocity and coronary flow reserve with Doppler wire before and after percutaneous transluminal coronary angioplasty

目的：评价经皮腔内冠状动脉成形术（ Ｐ Ｔ Ｃ Ａ）前后应用多普勒导丝测定冠状动脉血流速度及冠状动脉血流储备的变化意义。方法：对 ２５ 例冠心病患者的 ３１ 支冠状动脉行 Ｐ Ｔ Ｃ Ａ。于 Ｐ Ｔ Ｃ Ａ 前后用多普勒导丝分别记录狭窄近端和远端的平均峰值血流速度（ Ａ Ｐ Ｖ），狭窄近、远端血流速度比（ Ｐ／ Ｄ Ｖ Ｒ）及冠状动脉血流速度储备（ Ｃ Ｆ Ｒ）。结果： Ｐ Ｔ Ｃ Ａ 前 ３１ 支冠状动脉的直径狭窄率为（８４．８８±１２．２５）％ 。 Ｐ Ｔ Ｃ Ａ 后残余狭窄为２７．６５％ （ Ｐ ＜ ０．０５），术后病变冠状动脉近端 Ａ Ｐ Ｖ 较 Ｐ Ｔ Ｃ Ａ 前有所增加，但差别未达统计学意义〔（２３．７４±１５．９８） ｃｍ ／ｓ∶（２７．３６±１８．３２ ｃｍ ／ｓ， Ｐ ＝０．０６〕。狭窄远端基础 Ａ Ｐ Ｖ、充血相 Ａ Ｐ Ｖ 及 Ｃ Ｆ Ｒ 均较术前明显增加〔（１５．０７±１１．６３） ｃｍ ／ｓ∶（２３．０９±１０．３３） ｃｍ ／ｓ，（２０．５３±１０．６９） ｃｍ ／ｓ∶（４１．６７±１７．４３）ｃｍ ／ｓ，１．２０±０．４０∶１．８１±０．６６，均 Ｐ ＜ ０．０５〕， Ｐ／ Ｄ Ｖ Ｒ 则明显降低（１．８４±１．０６∶１．４５±０．７４， Ｐ ＜ ０．０?

Objective:To report our experience using Doppler wire to assess of coronary hemodynamics before and after PTCA.Method:25 patients with 31 diseased coronary arteries (LAD16,RCA8,LCX7) were studied with intracoronary Doppler wire.The measurement included proximal and distal average peak velocity (APV),ration of peak velocity (P/DVR) between proximal and distal,maximal distal APV and coronary flow reserve (CFR) at basic state and after PTCA.Result:Narrowing percentage in diameter for the 31 coronary arteries decrased from ( 84.88 ± 12.25 )% before PTCA to 27.65 % after PTCA (P< 0.05 ).After PTCA the proximal APV increased but was not significant 〔( 23.74 ± 15.98 ) cm/s∶( 27.36 ± 18.32 )cm/s,P= 0.06 〕.The distal APVb、APVp and CFR were increased significantly 〔( 15.07 ± 11.63 )cm/s∶( 23.09 ± 10.33 )cm/s,( 20.53 ± 10.69 )cm/s∶( 41.67 ± 17.43 )cm/s, 1.20 ± 0.40 ∶ 1.81 ± 0.66 ,P< 0.05 〕.P/DVR decreased significantly from 1.84 ± 1.06 before PTCA to 1.45 ± 0.74 after PTCA(P< 0.05 ).However,the degree of stenosis decreasing did not show significant correlation with changes of basic APV,maximal APV,CFR and P/DVR after PTCA (r=- 0.11 ,- 0.11 - 0.18 , 0.28 ,respectively,all P> 0.05 ).Conclusion:Changes of coronary artery dynamics and acute result measured by CFR after PTCA can be evaluated accurately with Doppler wire.The significance of Doppler wire measurement during PTCA needs further extending studies.