经食管超声心动图测定冠状窦血流对心肌肥厚患者冠脉血流储备的诊断价值

目的 探讨多平面经食管超声心动图（ＴＥＥ）测定冠状窦血流评估心肌肥厚患者冠脉血流储备（ＣＦＲ）的可行性及对心肌肥厚的诊断价值。方法 对４２例心肌肥厚患者和１０例正常对照静脉注射潘生丁,分别测量静息状态（Ｒｅｓｔ）及注射潘生丁后（ＤＰＭ）冠状窦血流频谱收缩期、舒张期、舒张末期逆行心房波最大流速（Ｓ、Ｄ、Ａ）及流速积分（ＶＴＩ－Ｓ、ＶＴＩ－Ｄ、ＶＴＩ－Ａ）,以（ＶＴＩ－Ｓ＋ＶＴＩ－Ｄ）－（ＶＴＩ－Ａ）     

脉冲多普勒超声心动图对高血压病人冠脉血流储备的测定

目的　应用经胸脉冲多普勒超声心动图 (PDE)测定高血压病人的冠脉血流储备功能 (CFR)。方法　 2 0例正常人和 3 5例无并发症的轻中度原发性高血压病人经静脉注射潘生丁 ,测量用药前后左冠状动脉主干舒张期峰值速度 ,计算其比值作为冠脉血流储备指标。结果　高血压病人无论是否伴有心肌肥厚均伴有冠脉血流储备指标D/RPDV的减低 ,差异显著 (P <0 .0 1)。结论　原发性高血压病人均存在冠脉血流储备减低     

经食管超声研究卡维地洛对原发性高血压左室肥厚患者冠脉血流储备的作用

目的 探讨卡维地洛对原发性高血压（EH）左室肥厚患者冠脉血流储备的作用。 方法 应用经食管超声技术，筛选出28例EH病左室肥厚患者作为研究对象。卡维地洛治疗前后行经食管超声检查，记录潘生丁负荷状态及基础状态下冠脉血流参数，计算冠状动脉储备（CFR）。 结果 28例高血压左室肥厚患者卡维地洛治疗后CFR显著性升高（P〈0．05）；基础状态及潘生丁应用后充血状态冠脉血流速度及血流速度积分均有升高，其中充血状态差异有显著性（P〈0．05）。卡维地洛治疗后左室质量指数显著下降（P〈0．05）；卡维地洛治疗后增加的冠脉血流储备（△CFR）与左室质量指数下降的数值（△LVMI）呈负相关（r=-0．39，P=-0．038）。 结论 卡维地洛能显著地升高EH左室肥厚患者CFR；具有消退EH左室肥厚的作用；CFR的改善与肥厚的逆转有关。     

Evaluation of Coronary Flow Velocity Reserve in Homozygous Familial Hypercholesterolemia by Transthoracic Doppler Echocardiography and Dual-Source Computed Tomography

Homozygous familial hypercholesterolemia (HoFH) is a rare disorder characterized by the early onset of atherosclerosis and usually occurs at the ostia of coronary arteries. In this study, we used transthoracic Doppler echocardiography (TTDE) to evaluate the dynamic changes of coronary flow in HoFH patients and to detect aortic and coronary atherosclerosis by dual-source computed tomography (DSCT). We studied 20 HoFH patients (12 females, 8 males, mean age 13.1 ± 5.3 years, with a mean low density lipoprotein (LDL) cholesterol of 583 ± 113 mg/dL) and 15 control patients (8 females, 7 males, mean age 15.2 ± 6.9 years, with a mean LDL cholesterol 128 ± 71 mg/dL) using TTDE and DSCT. None of the patients showed evidence of ischemia with standard exercise testing. Though the baseline coronary flow was similar between HoFH patients and normal controls, the hyperemic flow velocities and, thus, the coronary flow velocity reserve (CFVR) were significantly lower in those with HoFH. All HoFH patients had aortic plaques, nine of them with the coronary artery ostia simultaneously, who had significantly higher LDL-cholesterol and lower CFVR than those without ostia plaques. Our data demonstrated that TTDE together with DSCT could be a useful noninvasive method for detection of coronary flow dynamics and atherosclerosis specifically in HoFH subjects with coronary ostia. (E-mail: lizhian_anzhen@yahoo.com.cn)     

高血压患者冠状动脉血流储备下降对左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（Coronary flow reserve, CFR）对左室舒张功能的影响。 方法 86例血压控制达标且经冠脉造影或冠脉CT检查证实冠脉狭窄<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CFR<3者47人（54.65%）,CFR为2.35±0.40,CFR≥3者39人（45.35%）,CFR为3.45±0.36;CFR<3的患者CFR与ATP负荷后侧壁Em呈正相关（r=0.42,P=0.003）,多元线性回归分析显示CFR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约50%存在冠脉微循环障碍;有微循环障碍的高血压患者CFR下降是左室舒张功能减退的独立影响因素。     

Myocardial perfusion in patients with typical chest pain and normal angiogram

BACKGROUND: Approximately 10-30% of patients with typical chest pain present normal epicardial coronaries. In a proportion of these patients, angina is attributed to microvascular dysfunction. Previous studies investigating whether angina is the result of abnormal resting or stress perfusion are controversial but limited by varying inclusion criteria. Therefore, we investigated whether microvascular dysfunction in these patients is associated with perfusion abnormalities at rest or at stress. PATIENTS AND METHODS: In 58 patients (39 female, 19 male, mean age 58+/-10 years) with angina and normal angiogram as well as 10 control patients with atypical chest pain and normal coronaries (six female, four male, mean age 53+/-11 years) myocardial blood flow (MBF) was measured at rest and under dipyridamole using 13N-ammonia PET. Resting MBF and coronary flow reserve (CFR) as the ratio of hyperaemic to resting MBF were corrected for rate-pressure-product (RPP): normalized resting MBF (MBFn)=MBFx10,000/RPP and CFRn=CFRxRPP/10,000. RESULTS: Sixteen/58 patients had a normal CFRn (=2.5; group I; CFRn: 3.1+/-0.88); the same as the controls (CFRn: 3.3+/-0.74). Forty-two/58 patients presented a reduced CFRn (group II; CFRn: 1.78+/-0.57). Group II had both a higher MBFn (group II: 1.30+/-0.33 vs. Group I: 1.03+/-0.26; P<0.05 and vs. controls: 1.07+/-0.19; P<0.01) and a lower hyperaemic MBF (group II: 2.25+/-0.76 mL g-1 min-1 vs. Group I: 3.07+/-0.78 mL g-1 min-1; P<0.001 and vs. controls: 3.41+/-0.94 mL g-1 min-1; P<0.0001). CONCLUSION: Impaired CFRn in patients with typical angina and normal angiogram is owing to both an increased resting and reduced hyperaemic MBF. Therefore, PET represents a prerequisite for further studies to optimize treatment in individuals with anginal pain and normal coronary angiogram.     

冠心病患者冠脉血流储备变化的临床意义

用食管多普勒超声心动图研究２０例正常人，３７例冠心病患者的冠脉血流储备（ＣＦＲ）。在左冠状动脉主于分枝处用脉冲多普勒测定舒张期最大血流速度（ＰＤＶ）和收缩期最大血流速度（ＰＳＶ）。以潘生丁静注后和静息时的ＰＤＶ比率（Ｄ／ＲＰＤＶ）和ＰＳＶ比率（Ｄ／ＲＰＳＶ）作为ＣＦＲ指标（Ｉｌｉｃｅｔｏ氏法）。结果发现冠心病患者Ｄ／ＲＰＤＶ，Ｄ／ＲＰＳＶ分别为１．５６±０．４１，１．４３±０．３０较正常人２．５９±０．７０，２．３８±０．５８明显减少（Ｐ＜０．０１），冠心病患者３２／３７（８６．５％）例Ｄ／ＲＰＤＶ，Ｄ／ＲＰＳＶ＜２．０，正常人仅１／２０（５％）例＜２．０；ＣＦＲ下降对冠心病的检出率除了运动ＳＰＥＣＴ心肌断层显像外均较其它无创检查法高。这些资料表明：经食管多普勒超声心动图可检出冠心病患者的ＣＦＲ有明显减退，ＣＦＲ下降可作为检出冠心病的一种无创性敏感检查方法。