冠脉内多普勒血流储备与核素心肌显像潘生丁试验的对比研究

Intracoronary Doppler Flow Reserve Versus Dipyridamole Emission Computed Tomographic 201T1 or ^(99m)Tc-Sestamibi Myocardial Imaging

目的 比较冠脉内多普勒血流储备与核素心肌显像潘生丁试验结果。方法 2 7例行冠脉造影和冠脉内多普勒血流速度测定的患者 ,共 5 5支冠脉 ,重度狭窄 (≥ 75 %直径狭窄 ) 12支 ,轻中度狭窄 12支 ,无狭窄 31支。另取 8例冠脉造影正常且无冠脉微血管病变基础者作为正常对照组 ,共 19支冠脉。用CardiometricsFlomapⅡ和 0 .0 14或 0 .0 18英寸多普勒钢丝测量冠脉近端及远端平均峰速 (APV)、近端与远端流速比 (P/DVR)、舒张期与收缩期流速比 (DSVR)和CFR。结果与冠脉造影前潘生丁负荷试验 2 0 1T1或99mTc心肌显像潘生丁试验结果比较。结果 根据冠脉内多普勒测定结果将本组分为 :A组CFR >2 .0 ,33支冠脉 ;B组CFR≤2 .0 ,2 2支冠脉。结果发现 ,A组冠脉远端充血反应时APV显著高于B组 (P =0 .0 0 6 4) ,致其远端CFR明显高于B组 (P <10～ 7)。如以冠脉内多普勒CFR为参考 ,核素心肌显像潘生丁试验的灵敏度、特异度分别为72 .73%、93.94% ;如以核素心肌显像潘生丁试验结果为参考 ,冠脉内多普勒血流储备的灵敏度和特异度分别为88.89%和 83.78% ;两者符合率为 85 .45 %。结论 在评价冠脉储备功能方面 ,冠脉内多普勒血流储备与核素心肌显像潘生丁试验结果有较高的符合率 ,但尚不能相互替代。

Purpose To compare measures of coronary flow reserve by an intracoronary Doppler guide wire with results of dipyridamole emission computed tomographic 201T1/ 99m Tc sestamibi myocardial imaging(SPECT). Methods The coronary blood flow velocity were measured by Cardiometrics Flomap Ⅱand 0.014 or 0.018 inches Doppler flowire in 27 patients (55 arteries) with coronary angiography.8 patients (19 arteries )without underlying diseases of coronary microvascular lesions were studied as the normal control.The proximal and distal average peak velocity (APV),diastolic/systolic velocity ratio (DSVR),CFR and proximal/distal velocity ratio (P/DVR) were measured.The results were compared with that of SPECT before angiography. Results According to the CFR measured by Doppler flowire,the arteries were divided into two groups:Group A,consisted of 33 arteries with CFR>2.0.Group B consistedof 22 arteries with CFR≤2.0 .CFR of group A was significantly higher than that of group B ( P <10-7).Among 22 arteries with abnormal CFR,SPECT could detect 16.Among 33 arteries with normal CFR,all arteries except 2 showed normal SPECT.With intracoronary Doppler flowire as reference,the sensitivity and specificity of dipyridamole SPECT were 72.73% and 93.94%.With results of dipyridamole SPECT as reference,the sensitivity and specificity of intracoronary Doppler CFR were 88.89% and 83.78%.Their conformability rate was 85.45%. Conclusions In evaluating coronary reserve function,results of dipyridamole SPECT was rather conformable to measures of intracoronary Doppler CFR,but they cannot be replaced each other.