经胸彩色多普勒检测冠心病患者冠状动脉左前降支和右冠状动脉远端血流储备

目的评价经胸彩色多普勒超声心动图(TTDE)检测冠状动脉前降支(LAD)和右冠状动脉后降支(PDA)血流储备和开放程度的可行性。方法65例(男48例,女17例)连续临床诊断或疑似冠心病患者,平均年龄(58±14)岁,左室射血分数(49±8)%,用TTDE冠状动脉显像方式于心尖两腔切面显示LAD和PDA远端的血流,在基础状态和持续静脉注射腺苷(140μg·kg-1·min-1)情况下分别测定其冠状动脉血流储备(CFR),结果与冠状动脉造影对比。结果所有患者基础和充血状态LAD血流均得到显示(其中4例应用造影剂),55例患者PDA得到显示(5例应用造影剂),有2例患者PDA闭塞,因此LAD的检测成功率为100%(65/65),PDA的CFR检测成功率为87%(55/63),所有患者腺苷静脉注射时间均少于4min,CFR检测平均时间为(7.3±1.6)min。以CFR≤2.0和CFR≤1.8分别作为判断冠状动脉狭窄(≥50%)和显著狭窄(≥70%)的标准,准确性相近,诊断LAD和RCA狭窄的灵敏度、特异度和ROC曲线下面积分别为89%/93%,86%/84%,0.89/0.92,诊断显著狭窄的灵敏度、特异度和ROC曲线下面积分别为88%/89%,90%/83%,0.94/0.95。结论经胸多普勒超声心动图检测LAD和PDA成功率和诊断冠状动脉狭窄的准确性均较高,有重要临床价值。

Noninvasive assessment of left anterior descending and right coronary artery flow reserve by transthoracic Doppler echocardiography in patients with coronary artery disease

OBJECTIVE: To assess the feasibility of evaluation of CFR for LAD and right coronary artery (RCA) as well as diagnostic accuracy for patency of each vessel by transthoracic Doppler echocardiography (TTDE). METHODS: 65 consecutive patients (age 58 +/- 14, ejection fraction 49% +/- 8%, 48 men and 17 women) were studied for CFR by TTDE with adenosine infusion (140 microg.kg(-1).min(-1)). LAD flow was interrogated nearby the apex in modified 2-ch apical view. RCA flow was interrogated at mid posterior wall on distal part of the posterior descending branch (PDA) in modified 2-ch apical view for PDA. RESULTS: Flow for LAD was detected in all patients (4 with use of contrast agent) and for RCA in 55 patients (5 with contrast agent). Two patients had an occluded RCA. Feasibility of RCA flow detection was 55/63 (87%). In all patients maximal flow of each branch was detected in less than 2 min of adenosine infusion (140 mg.kg(-1).min(-1)). Total time for both CFR estimation was 7.3 +/- 1.6 min. Selecting 2.0 or 1.8 as CFR cut-off value for diagnosis of coronary stenosis (> or = 50% in diameter) or severe stenosis (> or = 70%) was found fitted for both LAD and RCA with similar diagnostic performance (sensitivity 89%/93%, specificity 86%/84%, area under curve 0.89/0.92 respectively, in stenosis diagnosis and sensitivity 88%/89%, specificity 90%/83%, area under curve 0.94/0.95 respectively in severe stenosis diagnosis). CONCLUSIONS: CFR evaluation of both distal LAD and PDA is of high feasibility and can provide high diagnostic yield for relevant vessel patency.