906例患者中冠状动脉内多普勒检查的安全性

The safety of intracoronary Doppler flow meamsurement in 906 patients

目的 是评价采用冠脉内多普勒导丝FloWire 进行冠脉内血流速度测定的安全性。方法 从 1993年到 1998年 ,共有 90 6例病人 (男性 70 4例 ,平均年龄 5 6 8± 10 8岁 )行冠脉内多普勒血流速度测定 ,血流描计仪采用CardiometricsFloMap ,多普勒导丝为 0 0 14英寸或 0 0 18英寸的FloWire ,为测定冠脉血流储备 ,采用冠脉内注射罂粟碱 (90例病人 ,右冠状动脉 8mg,左冠状动脉 12mg)或腺苷 (右冠状动脉 12 μg,左冠状动脉 18μg)诱发冠状动脉的最大扩张。 结果 在所有研究病人中 ,82 9例为非心脏移植病人 ,其中 6 17例为诊断性冠状动脉造影 (Ⅰ组 ) ,2 12例为冠脉内介入治疗病人 (Ⅱ组 ) ,77例为心脏移植术后病人 (C组 )。 90 6例病人中共有 2 7例 (2 98% )发生与多普勒血流测定有关的心血管并发症。在冠脉内注射腺苷后 ,15例病人 (1 6 6 % )发生较严重的短暂的心动过缓 (心脏停搏或Ⅱ度到Ⅲ度的房室传导阻滞 ) ,其中 14例发生在右冠状动脉 ,1例在左前降支。在多普勒导丝的送入过程中 ,9例 (0 99% )发生冠脉痉挛 (5例在右冠状动脉 ,4例在左冠状动脉 )。两例 (0 2 2 % )检查过程中发生室颤 (其中一例为冠脉内注射罂粟碱后 ,另一例为急性下壁心梗右冠状动脉急症球囊成形术后 ) ,低血压伴随心动过缓 1例 ,

Objective To evaluate the safety of intracoronary Doppler flow measurement using Doppler FloWire  Methods and Results A total of 906 patients were examined with intracoronary Doppler using a 0 014″ or a 0 018″ Doppler FloWire  For coronary flow reserve measurement, intracoronary injection of adenosine or papaverine was used Of the patients studied, 77 were cardiac transplant recipients, 829 were nontransplant patients, of whom 617 patients underwent diagnostic coronary procedures and 212 had coronary interventions In 27 (2 98%) of 906 patients adverse cardiac events were observed Fifteen (1 66%) of 906 patients developed severe transient bradycardia (asystole or Ⅱ° to Ⅲ° atrioventricular block) after intracoronary administration of adenosine Of which, 14 occurred in RCA and 1 in LAD Nine (0 99%) of 906 patients experienced coronary spasm during the passage of the Doppler wire (5 in RCA, 4 in LAD) Two (0 22%) of 906 patients developed ventricular fibrillation during the procedure Hypotension with bradycardia and ventricular extrasystole each occurred in one (0 11%) of 906 patients The incidence of complication was significantly higher in transplant recipients than in nontransplant patients underwent either diagnostic or interventional procedures (12 99% vs 2 43% vs 0 94%, P <0 001) The Doppler measurements in RCA was associated with higher incidence of complication especially that of bradycardia in comparison with LAD and LCX (RCA 5 87% vs LAD 1 05% vs LCX 0 17%, P <0 001) All complications were cured medically Conclusion Intracoronary Doppler flow measurement using Doppler wires and intracoronary administration of adenosine is a safe method However, severe complications such as bradycardia and coronary spasm can occur Attention should be paid when the examination of RCA and especially for heart transplanted recipients