冠状动脉内多普勒血流测定在冠状动脉造影正常者中的应用价值

Values of intracoronary Doppler flow measurement in patient with normal coronary angiograms

目的 本研究旨在通过对有胸痛但冠状动脉造影正常者行冠状动脉内多普勒血流速度测定 ,评价这组病人的冠状动脉血流储备功能及其影响因素。方法 对 12 6例冠状动脉造影正常而获得满意血流频谱病人 [男 6 7例 ,女 5 9例 ,平均年龄 (5 3 1± 13 0 )岁 ],采用冠状动脉内多普勒血流速度描记技术对左前降支进行血流速度测定 ,并经冠状动脉内注射腺苷 18μg后测定冠状动脉血流速度储备 (CFVR)。结果 12 6例病人的左前降支的CFVR平均值为 2 71± 0 74,基础冠状动脉平均峰值血流速度 (bAPV)为 (18 7± 7 2 )cm s,充血相平均峰值血流速度 (hAPV)为 (47 7± 15 2 )cm s。其中6 5 1%的病人CFVR低于 3 0 ,与CFVR正常者 (≥ 3 0 )相比 ,这组病人的bAPV较高而hAPV较低。CFVR与基础心率成负性直线相关 (r=- 0 34 8,P <0 0 0 1) ,而bAPV与基础心率呈正性直线相关 (r =0 376 ,P <0 0 0 1)。CFVR和bAPV与血压均无明显相关关系。有无高血压及高脂血症对CFVR无明显影响。糖尿病患者的CFVR低于无糖尿病的患者 (2 30± 0 47vs 2 80± 0 6 8,P =0 0 44 )。结论 有胸痛但冠状动脉造影正常的病人中约 2 3存在微血管功能障碍 ,冠状动脉血流储备功能受心率的影响 。

Objective The purpose of this study is to evaluate the coronary flow reserve in patients who had chest pain but normal coronary angiograms using intracoronary Doppler flow measurement Methods Intracoronary Doppler flow measurements in left anterior descending coronary arteries (LAD) were performed in a total of 126 patients (male 67, age 53 1±13 0 years) who had chest pain but normal coronary angiograms in all three vessels Intracoronary bolus injection of 18 μg adenosine was used to induce maximal coronary dilation Coronary flow velocity reserve (CFVR) was defined as the ratio of average peak velocity during hyperemia (hAPV) to that at baseline (bAPV) Results The mean value of CFVR of LAD was 2 71±0 74 with bAPV of (18 7±7 2)cm/s and hAPV of (47 7±15 2)cm/s Reduction of CFVR was found in 82 (65 1%) of 126 patients In comparison to the patients with normal CFVR (≥3 0), the patients with reduction of CFVR had a higher bAPV and lower hAPV (both P <0 05) No linear correlation was found between either bAPV or CFVR and systolic blood pressure and diastolic blod pressure A positive linear correlation was found between bAPV and heart rate at baseline ( r =0 376, P <0 001) A weak negative linear correlation existed between CFVR and heart rate at baseline ( r = -0 348 , P <0 001) No significant difference of flow velocity parameters was found between patients with history of hypertension and those without history of hypertension No significant difference of flow velocity parameters was found between patients with and without hyperlipidemia The CFVR was significantly lower in patients with diabetes mellitus compared with that in patients without diabetes mellitus (2 30±0 47 vs 2 80±0 68, P =0 044) Conclusion Microvascular dysfunction existed in about 2/3 of patients who had chest pain but normal coronary angiograms Heart rate had significant influence on coronary flow reserve Coronary flow reserve significantly decreased in patients with diabetes mellitus