Assessment of Coronary Flow Velocity Reserve by Noninvasive Transthoracic Doppler Echocardiography in Patients with Angiographically Normal Coronary Arteries

Summary： The measurement of coronary flow velocity reserve （CFVR） by transthoracic Doppler echocardiography （TTDE） with invasive intracoronary Doppler flow wire technique （ICD） was validated and the pathological factors which influence CFVR in patients with angiographically normal coronary arteries were analyzed. CFVR was determined successfully in left anterior descending artery （LAD） in 37 of 40 patients with angiographically normal coronary arteries （men 22, women 15, age 20-75 years, mean age 54±12 years）. Coronary flow velocity was measured in the distal LAD by TTDE with contrast enhancement at baseline and during intravenous adenosine infusion of 110 μg/ kg per min within 48 h after ICD technique. Average peak velocity at baseline （APVb）, average peak velocity during hyperemia （APVh） and CFVR determined from TTDE were correlated closely with those from ICD measurements （APVb： y= 0. 64x＋ 5. 04, r=0. 86, P〈0. 001; APVh： y=0. 63x＋14. 36, r=0.82, P〈0.001; CFVR： y=0.65xq-0.92, r=0.88, P〈0.001）. For CFVR measurements, the mean differences between TTDE and ICD methods were 0. 12±0.39. CFVR in patients with history of hypertension was significantly lower than that in patients without history of hypertension （P〈0.05）. Intravascular ultrasound （IVUS） was performed in 34 patients. Plaque formation was found in LAD by IVUS in 17 （50%） patients. No significant difference in CFVR was found between the patients without plaque formation （3. 11±0. 49） and those with plaque formation （2. 76±0.53, P=0. 056）. It is suggested that TTDE with contrast enhancement provides reliable measurement of APV and CFVR in the distal I.AD. The early stage of atherosclerosis could be detected by IVUS, which may be normal in angiography. CFVR is impaired in patients with history of hypertension compared with that in patients without history of hypertension.

Non-invasive Assessment of Coronary Flow Velocity Reserve: A New Method Using Transthoracic Doppler Echocardiography

Summary: Transthoracic Doppler echocardiography (TTDE) allows noninvasive flow measurement in the distal left anterior descending artery (LAD). The feasibility of detecting coronary flow by contrast-enhanced TTDE with second harmonic technique was assessed, the coronary flow velocity reserve (CFVR) was evaluated in comparison to intracoronary Doppler flow (ICD) analysis and the CFVR after PTCA in LAD was investigated. In 77 (96 %) of 80 patients, CFVR was successfully determined with intravenous adenosine infusion. Doppler signal quality was evaluated in the first 46 patients by use of intravenous Levovist infusion and second harmonic technique. The Doppler flow was not visible in 1 patient only. CFVR determined from TTDE (2.77±0.65) was correlated closely with those from ICD (2.88±0.78) measurements (y=0.73x+0.67, r=0.87, P<0.001). In conclusion, TTDE is a feasible method and provides reliable data on CFVR which can be used for follow-up after PTCA.

Value of Acceleration Flow in the Left Anterior Descending Coronary Artery for the Detection of Coronary Artery Stenosis by Transthoracic Coronary Color Doppler Echocardiography

Summary： Whether the localized flow acceleration occurs in the resting stenotie left anterior descending coronary artery was explored and its value for detection of coronary stenosis estimated. Blood flow in the left anterior descending coronary arteries in 45 patients was detected by transthoratio color Doppler echocardiograph and multipoint pulse Doppler spectrums were recorded in the same segment. The ratio of the maximal peak diastolic velocity to the minimal peak diastolic velocity was calculated. The ratio ≥1.5 was the cutoff value for the presence of localized acceleration flow. There were 23 patients with localized acceleration flow examined by eehoeardiography. Twenty of them were found to have luminal diameter stenosis （60%-98%） in the left anterior descending coronary arteries by coronary angiography and 3 patients were normal. There were 22 patients without localized acceleration flow examined by eehoeardiography. Eighteen of them had no or %60 stenosis. Four patients had serious stenosis （≥95%） or occluded segments in the left anterior descending coronary arteries on coronary angiography. The ratio of the maximal peak diastolic velocity to the minimal peak diastolic velocity was significantly higher in patients with left anterior descending coronary artery stenosis than that in those without stenosis （1.9±0.3 vs 1.3±0.2, P〈0.01） and it correlated significantly with left anterior descending coronary artery stenosis （r=0.77, P〈0.01）. The specificity by using the ratio≥1. 5 for stenosis detection was 85.7% （18/ 21）, and the sensitivity was 83.3% （20/24）. This study demonstrated that local blood flow velocity was increased in the resting stenotie left anterior descending coronary artery. Transthoraeie color Doppler eehoeardiography is a reliable noninvasive method to detect localized acceleration flow in the left anterior descending coronary artery stenosis and it is useful in the noninvasive diagnosis of stenosis in the left anterior descending coronary artery.

Usefulness of coronary flow reserve measured by transthoracic coronary Doppler ultrasound in the elderly

The left anterior descending （LAD） coronary artery is the main vessel of human coronary circulation, and life-threa- tening consequences are seen when flow in this area is im- paired, Noninvasive measurement of coronary flow re- serve （CFR）, defined as the ratio of maximal to baseline coronary blood flow, has been repeatedly shown to be a feasible technique by ultrasound transthoracic Doppler （TTD） both in the LAD and, with some limitations, in the posterior descending （PD） coronary artery.

Usefulness of Fractional Flow Reserve during Routine Clinical Procedures in All-Comer Coronary Artery Disease Patients

Background: Fractional flow reserve (FFR)-guided interventions, though proved to be safe, continue to be a much-underutilized modality in determining treatment strategy, and data is lacking in Indian population. Objective: We aimed to determine the use of FFR-guided PCI and assess the overall impact on treatment decisions and clinical outcomes in patients with acute coronary syndrome (ACS) or chronic coronary syndromes (CCS). Methods: In this single-center retrospective and prospective observational study, FFR had been performed for the evaluation of treatment reclassification and clinical outcomes, as per physician’s clinical practice. Results: Data was obtained for 250 subjects (mean age 60.45 ± 9.6 years) with 324 lesions. The treatment plan based on angiography alone changed in 28% of lesions post-hyperemic FFR. The initial treatment plan based on angiography vs. the final treatment plan post-FFR (>0.80) was medical management 56.5% vs. 66.0%;CABG 11.1% vs. 7.7%;and PCI 32.4% vs. 26.2%. In subjects initially assigned to medical management, 14% had changed to PCI, and for subjects initially assigned to PCI, 44% had changed to medical therapy. Receiver operating characteristics (ROC) curve analysis revealed a good correlation between a resting FFR value of <0.87 and hyperemic FFR value of <0.80. The rate of 2-year major adverse cardiovascular events (MACE) was 0.9%. Conclusion: This study supports the use of FFR in determining treatment strategy in ACS or CCS patients with low MACE. Resting FFR value of <0.87 may be an alternative to intracoronary nitroglycerine/adenosine/Nikorandil-induced FFR in predicting positive FFR particularly in hemodynamically unstable patients, and who are intolerant to hyperemic drugs.

经胸超声心动图联合超声造影检测冠状动脉血流储备对高血压患者冠状动脉病变的预测价值

目的 探讨经胸超声心动图联合超声造影检测冠状动脉血流储备(CFR)对高血压患者冠状动脉病变的预测价值。方法 纳入伴有左心室肥厚(LVH)的高血压患者45例作为观察组,另纳入45例单纯高血压患者作为对照组。对所有患者开展经胸超声心动图联合超声造影检查,比较两组经胸超声心动图检查结果及造影检查结果。结果 两组患者的静息舒张期峰值血流速度(PDV)比较无差异(P>0.05);观察组的负荷PDV(47.34±14.98)cm/s及CFR(1.94±0.78)低于对照组的(67.78±15.57)cm/s、(2.83±1.82)(P<0.05)。观察组灌注量(7.02±2.91)L/min、曲线峰值强度(9.46±7.62)dB、曲线斜率(1.23±1.03)dB/s低于对照组的(9.64±3.34)L/min、(16.78±8.43)dB、(1.78±1.22)dB/s,灌注阳性率71.11%高于对照组的22.22%(P<0.05)。结论 经胸超声心动图联合超声造影可实现对CFR的评估,帮助了解高血压患者的冠状动脉病变情况,为冠状动脉病变的防治提供依据。

Can transthoracic Doppler echocardiography be used to detect coronary slow flow phenomenon？

Background Coronary slow flow phenomenon （CSFP） is an important, angiographic clinical entity but is lacking non-invasive detecting techniques. This study aimed to elucidate the value of transthoracic Doppler echocardiography （TTDE） in the diagnosis and monitoring of coronary slow flow in left anterior descending （LAD） coronary artery.Methods We consecutively enrolled 27 patients with CSFP in LAD detected by coronary arteriography from August 2009 to April 2010. Thirty-eight patients with angiographically normal coronary flow served as control. Corrected thrombolysis in myocardial infarction （TIMI） frame count （CTFC） was used to document coronary flow velocities. All subjects underwent TTDE within 24 hours after coronary angiography. LAD flow was detected and the coronary diastolic peak velocities （DPV） and diastolic mean velocities （DMV） were calculated.Results Sixty of 65 （92.3%） subjects successfully underwent TTDE. Baseline clinical characteristics were similar between the two groups. Coronary DPV and DMV of LAD were significantly lower in the CSFP group than in the control group （（0.228±0.029） m/s vs. （0.302±0.065） m/s, P=0.000; （0.176±0.028） m/s vs. （0.226±0.052） m/s, P=0.000,respectively）. There was a high inverse correlation between CTFC and coronary DPV and DMV （r=-0.727, P=0.000;r=-0.671, P=0.000, respectively）. Receiver operating characteristic （ROC） curve showed that the area under the curve （AUC） was less than one half for coronary DPV （AUC=0.104） and DMV （AUC=0.204）, respectively.Conclusions In patients with CSFP, there is a high inverse correlation between CTFC and coronary diastolic flow velocities in the LAD coronary artery, as measured by TTDE. The value of TTDE in the monitoring and evaluation of coronary flow in patients with CSFP deserves further investigation.

Effects of hypoxia on coronary flow reserve as determined by myocardial contrast echocardiography in swine

Background Time-intensity curves derived from microbubble destruction/refilling sequences and recorded using myocardial contrast echocardiography (MCE) can provide parameters that correlate with coronary blood flow. The response of these parameters to adenosine vasodilatation correlates with coronary flow reserve (CFR) measured by fluorescent microsphere techniques (FMT). Currently, no data exist regarding the effect of physiological variables, such as hypoxia, on the determination of CFR by MCE. The purpose of this study was to define the effects of decreases in blood partial pressure of oxygen (PO_2) on CFR as measured by MCE. Methods Studies were performed in 9 closed chest swine. Low-energy, real-time MCE was performed with commercial instruments in short axis view at papillary muscle level while infusing BR_1 at 30 ml/h. High-energy ultrasound bursts (referred to as FLASH frames) destroyed the bubbles every 15 cardiac cycles, and resultant time-intensity curves derived from these sequences were fitted to the exponential function y = A (1-e -bt) +c, from which the rate of signal rise (b) was obtained. CFR was calculated as the ratio of b values after adenosine infusion to baseline and was obtained during the control period and after decreasing blood PO_2 by giving nitrogen via a respirator to create artificial hypoxic conditions. CFR was independently determined by FMT. Results Nitrogen led to significant decreases in mean PO_2, from (120.6±18.9) mmHg to (51.8±15.9) mmHg (P<0.01). Adenosine produced a similar increase in CFR (2.5 fold vs 3.1 fold) as assessed by MCE and FMT during the control period. The decrease in PO_2 post nitrogen resulted in a slight increase in values at rest: 0.46±0.15 to 0.53±0.18 for b and (1.39±0.66) ml·min -1·g -1 to (1.72±0.30) ml·min -1·g -1 for myocardial blood flow (MBF) (both P<0.05). In addition, values decreased in response to adenosine using both techniques: 1.05±0.35 to 0.82±0.27 for b and (4.30±3.16) ml·min -1·g -1 to (3.93±1.27) ml·min -1·g -1 for MBF (both P<0.05). Thus, CFR was markedly reduced under hypoxic conditions, to 1.4 by MCE (P<0.05 compared with the baseline), and to 2.5 by FMT (P>05 compared with the baseline). Conclusions CFR values diminish under hypoxic conditions according to both MCE and FMT. The reductions in CFR involve both an increase in resting values and a decrease in post adenosine measurements, as determined by both techniques. The reduction in CFR under hypoxia is slightly greater using MCE than using FMT. Physiological variables, such as hypoxia, must be taken into consideration when assessing CFR by MCE.

基于默里定律的定量流量比诊断心脏结构异常和左心室舒张功能障碍患者的准确性

目的旨在从单一血管造影角度深入探讨基于默里定律的定量流量比(Murray-law quantitative flow ratio,μQFR)在诊断心脏结构异常和左心室舒张功能障碍患者中的准确性。方法回顾分析2018年1月至2018年12月期间广东省人民医院收治的90例患者的90条血管数据。这些患者在接受干预前接受了血流储备分数(fractional flow reserve,FFR)和μQFR检测,同时通过超声心动图评估了心脏结构和功能。FFR≤0.80被定义为具有血流动力学意义的冠状动脉缺血。结果μQFR与FFR之间存在中等程度的相关性(r=0.75,P<0.001),但Bland-Altman图显示两者之间存在一定的差异(平均差异=0.00;标准差=0.08;P=0.69)。根据FFR标准,μQFR的诊断准确率、敏感度、特异度、阳性预测值(positive predictive value,PPV)和阴性预测值(negative predictive value,NPV)分别为95.56%(95%CI:89.01%~98.78%)、90.91%(95%CI:89.01~98.09)、98.25%(95%CI:90.61~99.96)、96.77(95%CI:81.04~99.53)和94.92%(95%CI:86.38~98.21)。进一步分析表明,μQFR/FFR的一致性与左心室舒张功能和心脏结构异常之间无显著相关性(P>0.05)。结论μQFR与FFR之间存在良好的一致性,且在心脏结构异常和左心室舒张功能障碍患者中,μQFR的诊断准确性并未受到显著影响。

无创左室压力应变曲线在冠心病心肌缺血诊断中的价值

目的以冠状动脉血流储备分数(fraction flow reservation,FFR)为金标准,采用无创左室压力应变环(pressure strain loop,PSL)评价心肌做功相关参数对冠状动脉粥样硬化性心脏病(coronary artery disease,CAD)心肌缺血的诊断价值。方法前瞻性纳入2020年12月至2021年12月在复旦大学附属中山医院就诊的53例临床疑似CAD患者,均进行超声心动图检查、有创冠状动脉造影和FFR测量。根据冠脉造影结果将患者分为心肌缺血组(FFR≤0.8,24例)和非心肌缺血组(FFR>0.8,29例)。采用PSL进行脱机分析,获得左室整体做功指数(global work index,GWI)、整体有效功(global constructive work,GCW)、整体无效功(global wasted work,GWW)、整体做功效率(global work efficiency,GWE)、整体正向功(global positive work,GPW)及整体收缩期有效功(global systolic constructive work,GSCW)等心肌做功参数值,进行两组间比较。采用ROC曲线分析心肌做功参数对心肌缺血的诊断效能。结果在18、16和12节段水平,与非心肌缺血组相比,心肌缺血组GWI、GCW、GPW、GSCW均降低(P<0.001)。ROC曲线显示,GWI、GCW、GPW、GSCW在18节段水平AUC分别为0.803(95%CI 0.679~0.927)、0.807(95%CI 0.687~0.928)、0.822(95%CI 0.708~0.936)、0.819(95%CI 0.703~0.935)。其中,GWI最佳截断值为1676.3 mmHg%,预测心肌缺血的灵敏度、特异度和准确度分别为70.8%、86.2%和79.2%;GCW最佳截断值为1999.4mmHg%,预测心肌缺血的灵敏度、特异度和准确度分别为75.0%、82.8%和79.2%。结论采用PSL分析心肌做功对CAD心肌缺血人群有较好的筛查作用。

ATP Stress Myocardial Contrast Echocardiography Assessment of Coronary Microvascular Disease with Spasmodic Characteristics: A Case Report

Here, a patient with chest pain and <50% stenosis on coronary angiography, where ATP stress myocardial contrast echocardiography (MCE) revealed that coronary flow reserve was reduced to 1.71 was presented. Perfusion delay occurred in the left ventricular wall of the apex of the heart before ATP stress, and the perfusion delay area was significantly reduced at peak stress. Similar to the characteristics of "reverse redistribution" of radionuclide myocardium perfusion in coronary vasospasm, the delayed perfusion area in the recovery period was larger than that detected before stress. Together with increased spectral resistance of the distal segment of left anterior descending coronary artery and chest pain, these findings indicated coronary microvascular disease with spasmodic characteristics in this patient. The perfusion characteristics on ATP stress determined by MCE and changes in coronary spectrum have value for the diagnosis and treatment of coronary microvascular disease with spasmodic characteristics.

Impact of uncontrolled blood pressure on diagnostic accuracy of coronary flow reserve for detecting significant coronary stenosis in hypertensive patients

Background Impaired coronary flow reserve （CFR） in patients with hypertension may be caused by epicardial coronary stenosis or microvascular dysfunction. Antihypertensive treatment has been shown to improve coronary microvascular dysfunction. The aim of this study was to evaluate the impact of uncontrolled blood pressure （BP） on diagnostic accuracy of CFR for detecting significant coronary stenosis. Methods A total of 98 hypertensive patients scheduled for coronary angiography （CAG） due to chest pain were studied. Of them, 45 patients had uncontrolled BP （defined as the office BP 〉140/90 mmHg （1 mmHg=0.133 kPa） in general hypertensive patients, or ≥130/80 mmHg in hypertensive individuals with diabetes mellitus）, and the remaining 53 patients had well-controlled BP. CFR was measured in the left anterior descending coronary artery （LAD） during adenosine triphosphate-induced hyperemia by non-invasive transthoracic Doppler echocardiography （TTDE） within 48 hours prior to CAG. Significant LAD stenosis was defined as 〉70% luminal narrowing. Diagnostic accuracy of CFR for detecting significant coronary stenosis was analyzed with a receiver operating characteristic analysis. Results CFR was significantly lower in patients with uncontrolled BP than in those with well-controlled BP （2.1±0.6 vs. 2.6±0.9, P〈0.01）. Multivariate linear regression analysis of the study showed that the value of CFR was independently associated with the angiographically determined degree of LAD stenosis （β= -0.445, P 〈0.0001） and the presence of uncontrolled BP （β= -0.272, P=0.014）. With a receiver operating characteristic analysis, CFR 〈2.2 was the optimal cut-off value for detecting LAD stenosis in all hypertensive patients （AUC 0.83, 95% CI 0.75-0.91） with a sensitivity of 75%, a specificity of 78%, and an accuracy of 77%. A significant reduction of diagnostic specificity was observed in patients with uncontrolled BP compared with those with well-controlled BP （67% vs. 93%, P=0.031）. Conclusions CFR measurement by TTDE is valuable in the diagnosis of significant coronary stenosis in hypertensive patients. However, the diagnostic specificity is reduced in patients with uncontrolled BP.

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

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。

经胸冠脉血流显像技术无创性评价冠脉血流储备的临床研究

目的 ①探讨经胸冠脉血流显像技术评价正常人冠脉血流储备（ＣＶＲ）的可行性及测值可信性。②探讨年龄对冠脉血流储备的影响。方法 选取健康成人５８ 例，按年龄分组，评价各年龄段人群的冠脉血流贮备。结果 ①三支血管显像率：前降支（ＬＡＤ）为９０ ％ ，后降支（ＬＣＸ）为７５％ ，ＰＤ 为８１％ 。②潘生丁药物负荷试验能诱导冠状动脉明显充血反应，出现最大充血反应时间为６－２ ±２－２ｍｉｎ，各血流动力学指标测值明显高于用药前测值（ Ｐ＜ ０．００１） 。③随着年龄增加，冠脉血流储备明显降低。结论 冠脉血流显像新技术可实时、定量地对正常人冠脉血流进行更详尽功能分析。

高血压患者冠状动脉血流储备下降对左心室舒张功能减退的影响

目的探讨血压控制达标的高血压患者冠状动脉血流储备(CFR)对左心室舒张功能的影响。方法对86例血压控制达标、且经CAG或冠状动脉CTA证实冠状动脉狭窄<50%的高血压患者行经胸多普勒超声心动图ATP负荷试验,检测冠状动脉左前降支的CFR;测定ATP负荷前后左心室舒张功能参数,包括舒张早期、舒张晚期二尖瓣血流速度(E、A)和左心室侧壁及间隔二尖瓣环舒张早期、舒张晚期运动速度(Em、Am),分析CFR与左心室舒张功能参数的关系。结果入组患者总体CFR为2.85±0.67,其中47例CFR<3(2.35±0.40),39例CFR≥3(3.45±0.36)。CFR<3时,CFR与ATP负荷后侧壁Em呈正相关(r=0.42,P=0.003),且为ATP负荷后侧壁Em的独立影响因素(P=0.015)。结论血压控制达标且排除冠心病的高血压患者中,约50%存在冠状动脉微循环障碍;有微循环障碍的高血压患者CFR下降是左心室舒张功能减退的独立影响因素。

无创性CFR评价稳定型冠心病双支病变心肌缺血的临床价值

目的探讨经胸超声心动图(TTDE)法测量冠状动脉血流储备(CFR)评价稳定型冠心病前降支(LAD)和左旋支(LCX)病变心肌缺血、预测冠状动脉狭窄、选择治疗方案的临床价值。方法选取胸痛发作、已知或疑似冠心病患者56例,在TTDE冠状动脉血流显像模式下,于ATP注射前、中、后分别获取LAD和LCX远段血流频谱,测定其静息时及最大冠状动脉扩张时峰值流速,计算CFR。所有患者进行冠状动脉造影(CAG)及单光子发射计算机断层成像术(SPECT)心肌灌注显像检查。结果 1与SPECT心肌灌注显像对照,无创性CFR法评价心肌缺血差异无明显统计学意义(P>0.05),CFR≤2.0评价LAD病变相应供血区域心肌缺血的敏感性为93.3%,特异性为92.3%;CFR≤2.0评价LCX病变相应供血区域心肌缺血的敏感性为84.6%,特异性为85.7%;2CFR≤2.0预测冠状动脉狭窄率≥70%的敏感性为90.4%;特异性为90.5%;3TTDE测量CFR前降支成功率为96.4%(54/56);回旋支成功率73.2%(41/56)。结论 TTDE法无创性CFR可以作为评价稳定型冠心病冠状动脉双支病变心肌缺血的辅助判断手段,能够预测冠状动脉狭窄率并对治疗方案选择具有一定的临床指导价值。

川崎病患儿冠状动脉血流储备测定与影像形态学诊断的对照研究

目的评价持续冠状动脉病变对川崎病（KD）患儿冠状动脉血液动力学的影响,探讨冠状动脉血流储备（CFR）检测在KD患儿冠状动脉病变远期随访中的应用价值。方法选择因胸痛、心悸以及各类偶发早搏的患儿为对照组,KD并发持续左冠状动脉病变患儿为KD组,均予以ATP160μg·kg^-1·min^-1持续静脉注射,共6min。运用经胸多普勒超声心动图（TTDE）检测冠状动脉左前降支（LAD）在ATP注射前后的舒张期峰值流速（PDV）及平均流速（MDV）,并通过计算比值得出相应CFR（PDV）和CFR（MDV）值。结果对照组纳入25例,CFR（PDV）和CFR（MDV）值均与年龄呈显著正相关（r=0.596,0.591,P=0.002,0.002）;〈2岁、-8岁和〉8岁组的CFR（PDV）95%参考值范围分别为≥1.22、≥1.94和≥2.22。KD组纳入8例,静息状态下PDV和MDV值分别为（50.0±15.07）cm.s^-1和（35.16±11.52）cm.s^-1,显著高于对照组（P=0.004,0.015）;而CFR（PDV）和CFR（MDV）值明显降低,分别为（1.67±0.38）cm.s^-1和（1.69±0.47）cm.s^-1（P=0.002,0.018）。与对照组比较,KD组7/8例（87.5%）患儿CFR（PDV）值显著降低。结论持续冠状动脉病变可导致KD患儿CFR值显著降低,TTDE检测患儿CFR具无创、安全和便捷的优点,对于KD冠状动脉病变的长期随访与临床诊断治疗策略的选择具有指导意义。

血管内超声及血流储备分数检测对军事飞行人员冠心病的应用价值及意义

目的初步探讨冠状动脉造影、冠状动脉内超声以及血流储备分数检测对军事飞行人员冠心病医学鉴定的应用价值及意义。方法回顾分析冠状动脉造影、血管内超声以及血流储备分数检测在11例临床诊断军事飞行人员冠心病的应用及其相关医学鉴定情况,评价以上3种检测手段对军事飞行人员冠心病的应用价值。结果 11例军事飞行人员,年龄29~52岁,诊断为无症状性心肌缺血4例,心绞痛4例,陈旧性下壁心肌梗死2例,陈旧性前壁心肌梗死1例。11例均在我院行冠状动脉造影术,其中6例同时行冠状动脉造影＋血管内超声＋压力导丝测定,3例行冠状动脉造影＋血管内超声检测,2例行冠状动脉造影＋压力导丝测定;其中3例为支架术后复查,有3例经测定后同时行支架植入术,6例为临界病变。飞行结论3例飞行合格,给予放飞,8例飞行暂不合格,地面观察。结论冠状动脉造影结合血管内超声及血流储备分数检测可以从解剖学及功能学上清晰、准确地评估冠状动脉病变,从而为军事飞行人员冠心病的医学鉴定提供更为客观全面的依据。

冠状动脉介入治疗术中的微循环灌注及其检测手段

临床广泛应用的再灌注治疗评价指标主要针对的是心内膜下冠状动脉,近年来越来越多的证据表明,冠状动脉微循环在心肌的血供中起着重要作用。有些急性心肌梗死患者,虽然通过血流重建治疗使梗死相关冠脉开通,但由于相关的冠脉微循环出现微栓塞,使近远期心血管事件发生率和死亡率增加;相反,另外一些急性心肌梗死患者虽然相关冠脉仍闭塞,但其灌注区的心肌微循环却可通过侧支循环得到灌注,预后良好。因此越来越多的临床医生开始关注微循环的灌注,出现了一系列针对微循环的评价指标。但是目前的技术尚无法在人体内直接观察微血管,微血管血流的测定也非常复杂,现回顾和展望微循环灌注的检测手段以及应用。

经胸壁多普勒超声心动图对冠状动脉血流的检测——与冠状动脉造影对照研究

目的 探讨经胸壁多普勒超声心动图 (TTDE)对冠状动脉远端血流检测的可行性。方法 采用TTDE探查 5 1例冠心病患者冠状动脉左前降支 (LAD)远端及右冠状动脉后降支 (PDA)血流 ,并与冠状动脉造影比较。结果 LAD的检出率为 94%,PDA的检出率为 75 %,PDA未检出组的心率明显快于检出组。彩色多普勒冠脉显像为心底部朝向心尖部的舒张期持续的线状血流信号 ,脉冲多普勒显示以舒张期为主的双期血流频谱 ,有 3例冠脉完全闭塞的患者检出舒张期负向血流。结论 TTDE可以较好地评价冠状动脉左前降支和右冠状动脉后降支血流 ,为临床提供一个无创的检查冠状动脉血流的新方法。