经胸多普勒超声心动图检测冠状动脉血流储备对高血压患者冠状动脉狭窄的预测价值

The Predictive Value of Coronary Flow Reserve in Diagnosing Coronary Stenosis by Transthoracic Doppler Echocardiography in Patients of Hypertension

目的：探讨经胸多普勒超声心动图（TTDE）检测冠状动脉血流储备（CFR）对高血压患者冠状动脉狭窄的预测价值。方法：选择132例因胸痛拟行冠状动脉造影（CAG）的患者,根据是否有高血压分为高血压组（n=95）及非高血压组（n=37）。在CAG前2天内行TTDE-三磷酸腺苷（ATP）负荷试验检测冠状动脉左前降支（LAD）的CFR,并比较高血压组及非高血压组的CFR,根据CAG结果,采用受试者工作特征（ROC）曲线分析全部患者及高血压组、非高血压组CFR诊断LAD狭窄≥70%的价值。结果：非高血压组与高血压组的LAD狭窄≥70%的患者比例组间比较差异无统计学意义（42.1%vs 35.1%,P〉0.05）;而高血压组的CFR较非高血压组降低[2.39±0.86 vs 2.87±1.12,P〈0.05],差异有统计学意义。CFR诊断LAD狭窄≥70%的ROC曲线下面积在全部患者、高血压组及非高血压组分别为0.884[95%可信区间（CI）：0.83-0.94,P〈0.0001]、0.874（95%CI：0.81-0.94,P〈0.0001）、0.915（95%CI：0.82-0.98,P〈0.0001）。以CFR≤2.20为截点,对全部患者的诊断敏感性为80.3%,特异性为83.5%,准确性为80.3%。对高血压组患者的诊断敏感性为77.5%,特异性为80.0%,准确性为78.9%;非高血压组患者的诊断敏感性为69.2%,特异性为9 1.7%,准确性为83.8%。结论：有胸痛症状的高血压患者CFR较非高血压患者降低,提示存在微循环功能异常,对这些患者用CFR预测有意义的LAD狭窄具有较好的诊断价值。

Objective： To assess the predictive value of coronary flow reserve （CFR） for diagnosing coronary stenosis by transthoraeic Doppler echocardiography （TTDE） in patients with hypertension. Methods： A total of 132 patients scheduled for elective coronary angiography （CAG） due to chest pain were enrolled. The patients were divided into 2 groups： Hypertension group, n=95 and Non-hypertension group, n=37. The CRF of left anterior descending coronary artery （LAD） was measured by ATP stress TTDE at 2 days before CAG in all patients and the results were compared between 2 groups. ROC curve was conducted to assess CFR value in diagnosing LAD stenosis which was defined by LAD luminal diameter stenosis 〉 70% in relevant patients. Results： The condition of LAD stenosis was similar between 2 groups （42.1% vs. 35.1%）, P〉0.05. The CFR value in Hypertension group was lower than that in Non-hypertension group （2.39 ± 0.86） vs. （2.87 ~ 1.12）, P〈0.05. The ROC curve for diagnosing LAD stenosis in all patients were at 0.884 （95% CI 0.83-0.94, P〈0.0001）, in Hypertension group at 0.874 （95% CI0.81-0.94, P〈0.0001） and in Non-hypertension group at 0.915 （95% CI 0.82-0.98, P〈0.0001）. With the cut-off point of CFR 〈 2.2, it had the diagnostic sensitivity, specificity and accuracy in all patients were at 80.3%, 83.5% and 80.3%; in Hypertension group were at 77.5%, 80.0% and 78.9%, in Non-hypertension group were at 69.2, 91.7% and 83.8% respectively. Conclusion： The patients of hypertension combining chest pain had decreased CFR which implied the dysfunction of their microcirculation. CFR had the better diagnostic value for predicting the significant LAD stenosis in such patients.