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 pathologica...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.展开更多
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...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.展开更多
In order to study the mechanism of angiographic coronary slow flow phenomenon (SF), intracoronary ultrasound (ICUS) and Doppler (ICD) were performed in 14 patients with angiographic SF phenomenon but with normal angio...In order to study the mechanism of angiographic coronary slow flow phenomenon (SF), intracoronary ultrasound (ICUS) and Doppler (ICD) were performed in 14 patients with angiographic SF phenomenon but with normal angiograms and in 16 patients with normal angiographic coronary flow (NF). A 3.5 F, 20 MHz ultrasound catheter (Boston Scientific) was used for ICUS and a 0.014 inch FloWire (Cardiometrics) was used for ICD. Coronary flow velocity including average peak velocity (APV), maximal peak velocity (MPV) at rest and at hyperemia as well as coronary flow reserve (CFR) were compared in both groups in comparison to the presence or absence of plaque formation based on ICUS. CFR in the SF group (4.2±1.1) was even higher than that of the NF group (3.1±0.6, P<0.001). Department of Cardiology, University GHS Essen, Germany (Ge JB, Simon H, Jeremias A, Liu FQ, Grge G, Haude M, Baumgart D and Erbel R) Significant differences were also found concerning the APV and MPV among both groups (both P <0.001). Plaque formation was found in 7/13 patients with a lumen reduction of 21%±24% in SF group and in 7/16 of the NF group with a lumen reduction of 19%±17%. Comparison of APV, MPV and CFR in SF and NF grups. Comparison of APV, MPV and CFR in SF and NF groups[BHDFG1*2,WK8ZQ1,WK11DW,WK11DWW] SF group NF groupAPV (cm/s) Rest 7.7±2.0 21.1±5.0 * Peak31.7±14.961.3±14.2 *MPV (cm/s) Rest17.4±4.637.0±11.4 * Peak56.8±14.981.8±17.7 *CFR4.2±1.13.1±0.6 # * P<0.001, #P=0.002. Coronary slow flow phenomenon in angiography indicates reduced resting flow velocity without reduction of coronary flow reserve.展开更多
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...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.展开更多
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...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。展开更多
文摘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.
文摘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.
文摘In order to study the mechanism of angiographic coronary slow flow phenomenon (SF), intracoronary ultrasound (ICUS) and Doppler (ICD) were performed in 14 patients with angiographic SF phenomenon but with normal angiograms and in 16 patients with normal angiographic coronary flow (NF). A 3.5 F, 20 MHz ultrasound catheter (Boston Scientific) was used for ICUS and a 0.014 inch FloWire (Cardiometrics) was used for ICD. Coronary flow velocity including average peak velocity (APV), maximal peak velocity (MPV) at rest and at hyperemia as well as coronary flow reserve (CFR) were compared in both groups in comparison to the presence or absence of plaque formation based on ICUS. CFR in the SF group (4.2±1.1) was even higher than that of the NF group (3.1±0.6, P<0.001). Department of Cardiology, University GHS Essen, Germany (Ge JB, Simon H, Jeremias A, Liu FQ, Grge G, Haude M, Baumgart D and Erbel R) Significant differences were also found concerning the APV and MPV among both groups (both P <0.001). Plaque formation was found in 7/13 patients with a lumen reduction of 21%±24% in SF group and in 7/16 of the NF group with a lumen reduction of 19%±17%. Comparison of APV, MPV and CFR in SF and NF grups. Comparison of APV, MPV and CFR in SF and NF groups[BHDFG1*2,WK8ZQ1,WK11DW,WK11DWW] SF group NF groupAPV (cm/s) Rest 7.7±2.0 21.1±5.0 * Peak31.7±14.961.3±14.2 *MPV (cm/s) Rest17.4±4.637.0±11.4 * Peak56.8±14.981.8±17.7 *CFR4.2±1.13.1±0.6 # * P<0.001, #P=0.002. Coronary slow flow phenomenon in angiography indicates reduced resting flow velocity without reduction of coronary flow reserve.
文摘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.
文摘目的：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。
