冠脉造影脉冲响应分析评价心肌微循环

Coronary Angiographic Impulse Response Analysis to Assess Myocardial Microcirculation

目的评价冠脉狭窄病人心肌微循环和冠脉血流动力学之间的变化关系。方法采用数字血管造影脉冲响应函数的原理 ,分析视频时间密度曲线 ,测定造影剂平均通过微循环时间倒数(Tmicro -1) ,作为局部心肌微循环灌注指标。结合定量冠脉造影 (QCA)、计算和测量冠脉流速并计算冠脉阻力 ,为研究心肌微循环和冠脉循环动力学提供定量指标。结果随着近段冠脉狭窄最小腔径 (MLD)缩小 ,Tmicro-1 减少(P<0.001) ;PCI治疗后 ,随着MLD增加 ,Tmicro-1 增加 ,两者之间呈良好相关 (r=0.87,P<0.001)。示意Tmicro-1 可作为评估冠脉狭窄程度的定量指标。急性冠脉综合征PCI治疗后 ,随着狭窄MLD增加 ,Tmicro-1 和冠脉流速、冠脉阻力均得到改善 ,但PCI前Tmicro-1 与冠脉流速之间并非线性相关(r=0.18,P>0.05) ,可能与大 (体循环 )、小 (微循环 )循环之间存在不同的影响因素有关 (如侧枝循环 )。结论利用数字血管造影脉冲响应原理 ,测定Tmicro -1作为评估近端冠脉狭窄局部心肌微循环的定量指标 ,结合定量冠脉造影、冠脉血流动力学定量指标 ,有助于提高常规冠脉造影解剖和生理、大 -小循环相结合的综合诊断水平。

Objective To assess changes of myocardial microcirculation and coronary hemodynamics in patients with coronary stenosis.Methods We established digital angiographic impulse response analysis system to analyze time_density cure and to measure inverse value of the mean transitted time for coronary miˉcrocirculation(Tmicro -1 )as an index of regional myocardial perfusion in combination with quantitative coronary analysis(QCA),coronary resistance and coronary flowvelocity by computer.We applied these indexes to20patients with coronary stenosis and12cases were treated with coronary percutaneous coronary intervention(PCI)among them.Results With increase of the degree of stenosis of proximal coronary,it's minimal luminal diameter(MLD)and Tmicro -1 decreased(P<0.001),After successful PCI treatment,the Tmicro -1 increased along with MLD increasing,and in linear correlation(r=0.87,P<0.001)with MLD.The data showed that Tmicro -1 may be an index for proximal coronary severity,on the other hand,Tmicro -1 and coronary flow velovity are in nonlinear correlation(r=0.18,P>0.05)before PCI treatment,this phenomenon may be related to the factors that influence macro and microcirculation such as collateal flow.Conclusions We thoughtthatthe indexTmicro -1 detected by coronary digital angiographic impulse respose analysis system,combined with QCA and coronary flow velocity would help to elevate integrated diagnosis level of coronary lesion in anatomy and physiology,as well as macro and microcirculation.