经胸冠状动脉超声血流动力学参数评价冠状动脉狭窄程度

Evaluation of coronary stenosis severity with transthoracic coronary echocardiography hemodynamic parameters

目的探讨经胸冠状动脉超声（TTE）血流动力学参数评估冠状动脉狭窄程度的价值。方法回顾性分析56例可疑冠心病患者的影像资料。测量冠状动脉正常组（无狭窄）、轻度狭窄组（狭窄率〈50%）、中度狭窄组（狭窄率50%~69%）及重度狭窄组（狭窄率70%~99%）狭窄处TTE舒张期峰值流速（PDV）,其远端最慢处流速（PDVDIS）及流速比值（PDV/PDVDIS）。并进行统计学分析。结果 TTE显示良好彩色血流的血管分支共113支;以CAG为金标准,其中冠状动脉正常组18支,轻度狭窄组19支,中度狭窄组30支,重度狭窄组46支。轻度狭窄组PDV、PDV/PDVDIS与冠状动脉正常组差异均无统计学意义（P均〉0.05）。中度狭窄组PDV、PDV/PDVDIS高于冠状动脉正常组（t=5.13、7.11）和轻度狭窄组（t=4.45、6.59）,重度狭窄组PDV、PDV/PDVDIS高于冠状动脉正常组（t=10.63、11.43）、轻度狭窄组（t=10.06、11.04）和中度狭窄组（t=7.07、5.17）,差异均有统计学意义（P均〈0.05）。PDV、PDV/PDVDIS与狭窄率呈正相关（r=0.82、0.87,P〈0.01）。诊断冠状动脉中、重度狭窄时,PDV阈值分别为40.48、58.52cm/s,敏感度分别为86.67%、86.96%,特异度分别为86.49%、92.54%;PDV/PDVDIS阈值分别为1.44、1.98,敏感度分别为90.00%、82.61%,特异度分别为97.30%、89.55%。结论冠状动脉狭窄率与TTE血流动力学参数有关,PDV及PDV/PDVDIS可用以评价冠状动脉狭窄程度。

Objective To evaluate the severity of coronary stenosis by transthoracic coronary echocardiography （TTE） hemodynamic parameters. Methods Imaging data of 56 patients with suspected coronary disease underwent TTE were ret- rospective analyzed. Peak diastolic velocity （PDV）, distal PDV（PDVDls） and PDV/PDVDIs of four groups, including nor- mal group （without stenosis）, mild stenosis group （stenosis rate 〈50%）, moderate stenosis group （stenosis rate 50%- 69%） and severe stenosis group （stenosis rate 70%-99%） were compared. The statistical analysis was performed. Re- sults There were 113 coronary arteries well examined by TTE. According to angiography results, there were 18 in normal group, 19 in mild stenosis group, 30 in moderate stenosis group and 46 in severe stenosis group. No significant difference of PDV and PDV/PDVDIs was found between normal group and mild stenosis group （both P〉0.05）. PDV and PDV/ PDVDIs of moderate stenosis group were higher than those of normal group （t= 5.13, 7.11） and mild stenosis group （t= 4. 45, 6.59, all P〈0.05）. And PDV and PDV/PDVDIs of severe stenosis group were higher than those of normal group （t = 10.63, 11.43）, mild stenosis group （t= 10. 06, 11.04） and moderate stenosis group （t= 7.07, 5.17, all P〈0.05）. There was positive correlation between TTE hemodynamic parameters （PDV, PDV/PDVDIs） and the severity of coronary stenosis （r=0. 82, 0.87, P〈0.01）. In diagnosis of moderate and severe stenosis of coronary artery, the cut-off value of PDV were 40. 48 and 58.52 cm/s with the sensitivity of 86.67%, 86.96% and the specificity of 86.49%, 92.54%. The cut-off value of PDV/PDVD,s were 1.44 and 1.98 with the sensitivity of 90.00 %, 82.61% and the specificity of 97.30 %, 89.55%. Conclusion PDV and PDV/PDVDIs can be used to evaluate the severity of coronary stenosis, because the stenosis rate related to TTE hemodynamie parameters.