冠状动脉支架置入术后左前降支血流变化及临床因素分析

Different prognosis of coronary stenting: distal left anterior descending coronary artery hemodynamics ultrasonography and analysis of clinical multi-factors

目的经胸冠状动脉多普勒血流显像评估左前降支(left anterier descending,LAD)支架置入术疗效的临床价值。方法 47例曾行LAD支架置入术的患者,根据是否发生左室重构分为恢复组(Left ventricular normal,LVN)35例、左室重构组(Left ventricular remodeling,LVR)12例,进行临床资料的相关分析。应用冠状动脉多普勒血流显像观察两组的LAD远端血流动力学变化,记录流速曲线,测定舒张期峰值流速(PVd)、收缩期峰值流速(PVs)及舒张期与收缩期峰值流速比值(DSVR),进行比较。结果①临床资料分析:急性心肌梗塞、心功能Killip分级>2、冠状动脉三支或弥漫病变、置入多支支架、支架长度>20mm均与左室重构明显相关;②两组LAD远端血流测值无明显差异,提示支架通畅。出现逆向血流提示侧支循环形成,管腔再狭窄。LVN组多呈明亮的连续线条状,提示存活心肌灌注改善;LVR组血管显示率低,血流信号呈黯淡、稀疏斑点样。发生再狭窄的例数较多。提示心肌再灌注不良。结论冠状动脉多普勒血流显像能直接观测LAD远端的冠脉血流,可为LAD冠脉支架置入术后的效果评估提供重要信息。

Objective To evaluate the value of the distal left anterior descending coronary artery （LAD） flow velocity measured by transthoracic Doppler echocardiography （TTDE） for the noninvasive assessment of the LAD stent implanta- tion. Methods 47 cases after performing Intracoronary Stent Implantation, namely Left ventricular normal group （LVN, 35 eases）, Left ventricular remodeling group （LVR, 12 cases）, were studied. The distal LAD flow signal was observed and the pulsed-Doppler velocity curve was recorded by TTDE. The peak diastolic flow velocity （PVd） and the peak systol- ic flow velocity （PVs） were measured. The diastolic systolic velocity ratio （DSVR） was calculated. Results Acute myo cardial infarction,Killips of cardiac function ~2, three or diffuse coronary artery disease, more than stent placement and length of stent longer than 20 mm with left ventricular remodeling were significantly correlated. The PVd, PVs and DSVR had no significant difference between two groups,means coronary recanalization. LVN group color display for a bright line- like, suggesting that myocardial perfusion improved survival and LVR group＇s dim the intermittent, prompted serious ad- verse myocardial reperfusion. Reverse flow suggested there was collateral circulation, except lumen Restenosis. Conclusion Monitoring of the distal LAD flow velocity by TTDE was useful in the noninvasive assessment efficacy after stent interven- tion for the LAD lesions.