低分子右旋糖酐在冠状动脉光学相干断层成像检查中的可行性研究

Feasibility Study of Low Molecular Weight Dextran for Optical Coherence Tomography in Coronary Artery

目的:探讨低分子右旋糖酐在冠状动脉光学相干断层成像(OCT)检查中的可行性。方法:入选2018~2020年首都医科大学附属北京友谊医院连续收治的拟行OCT检查的冠心病患者共90例,患者在接受冠状动脉造影检查后,以随机顺序分别使用对比剂、低分子右旋糖酐对同一冠状动脉行OCT检查,主要终点为两种冲洗介质所获得的OCT图像清晰节段率,以OCT检查前后患者肾功能变化、住院期间主要不良心血管事件为安全性观察指标。结果:使用对比剂、低分子右旋糖酐获得的OCT图像清晰节段率差异无统计学意义(92.1%vs.91.3%,P=0.16),结果具有良好的一致性。在平均每例患者成像次数方面,使用低分子右旋糖酐行OCT时的成像次数多于使用对比剂时的成像次数[(1.44±0.62)次vs.(1.23±0.54)次,P=0.02]。OCT检查前后患者的血清肌酐水平和估算肾小球滤过率均无明显变化(P均>0.05)。所有患者住院期间未发生主要不良心血管事件。结论:用低分子右旋糖酐和对比剂行冠状动脉OCT所获得的图像质量相似,低分子右旋糖酐用于冠状动脉OCT检查有较好的可行性和安全性,有望代替对比剂。

Objectives:To explore the feasibility of low molecular weight dextran in optical coherence tomography(OCT)of coronary artery.Methods:A total of 90 patients with coronary heart disease who were admitted to Beijing Friendship Hospital from 2018 to 2020 and planned to undergo OCT were enrolled.OCT imaging was performed on the same coronary artery segment using contrast agent and low molecular weight dextran in random order after coronary angiography.The primary endpoint was the clear segment rate of image of OCT imaging.Meanwhile,the changes in renal function were observed before and after procedure,and the major adverse cardiovascular events during hospitalization were used as safety indexes.Results:There was no significant difference in clear segment rate of image obtained by using contrast agent and low molecular weight dextran(92.1%vs.91.3%,P=0.16),and the results obtained by the two methods have good consistency.In terms of average imaging times per patient,the low molecular weight dextran group had more imaging times than the contrast agent group(1.44±0.62 vs.1.23±0.54,P=0.02).There were no significant changes in serum creatinine level and estimated glomerular filtration rate before and after OCT(both P>0.05).No major adverse cardiovascular events occurred during hospitalization.Conclusions:This study shows that the image quality of low molecular weight dextran and contrast agent is similar in OCT image acquisition process.It is feasible and safe to use low molecular weight dextran for qualitative evaluation of coronary arteries in OCT imaging,and low molecular weight dextran has the potential to replace contrast agents.