不同冠状动脉截段定量冠状动脉造影与血管内超声测值的差异与意义

The difference of quantitative coronary angiography and intravascular ultrasound in measuring diameter of different coronary artery segments

目的评价定量冠状动脉造影(QCA)与血管内超声(IVUS)在冠心病不同冠状动脉截段参考血管直径的测量差异。方法选择2015年12月至2018年10月在导管室同时行冠状动脉造影及IVUS检查的患者共278例,分别测量不同冠状动脉截段病变血管的参考血管直径,并进行比较,寻找相对简单的公式应用于两者内在联系,并随机选择额外300处病变(280例患者)血管进行验证分析。结果不同冠状动脉截段病变血管的参考血管直径QCA和IVUS测值之间存在显著差异,右冠状动脉直径IVUS测值较QCA测值大,旋支直径IVUS测值较QCA测值小,这种差异在血管远端更明显。通过线性回归分析,QCA测量的不同冠状动脉截段参考血管直径由相应公式推算出IVUS测出的直径,并通过额外300处血管病变测量的数值得到相应验证。结论不同冠状动脉截段定量冠状动脉造影与血管内超声测值之差具有规律性,有助于冠状动脉介入治疗中确定血管直径。

Objective To evaluate the difference of quantitative coronary angiography(QCA)and intravacular ultrasound(IVUS)in measuring diameter of different coronary segments.Methods 278 patients underwent both QCA and IVUS during selective coronary angiography from December 2015 to October 2018 in catheterization lab.The reference vessel diameter of stenosis segments of different coronary arteries was measured by QCA and IVUS,respectively.The relationship between the two measurements was determined and used to form formulas.The formulas were testified in 300 diseased vessel segments prospectively(280 patients).Results The measurements of reference coronary diameter in different diseased artery segments were significantly different between QCA and IVUS.Right coronary artery diameter measured by IVUS was larger than that measured by QCA,while left circumflex artery diameter measured by IVUS was smaller than that measured by QCA.Such difference was more obvious in distal vessel.Based on linear regression analysis,corresponding formulas were formed from QCA measurement of different reference segment.The formulas could predict the measurement of IVUS and the prediction accuracy was testified in following 300 diseased vessel segments.Conclusion There is a regularity difference between QCA and IVUS measurements of different coronary segments,which may be benefit in determining actual vessel diameter during coronary interventional treatment.