冠脉造影数字跟踪法测定冠脉血流速度与Doppler血流速度相关分析

目的研究冠脉造影数字跟踪技术测定冠脉血流速度与Doppler血流速度之间的相关性。方法入选住院冠脉造影病人40例,包括左前降支(LAD)单支病变行介入治疗(PCI)10例,诊断性冠脉造影30例(冠脉造影正常、心肌桥、轻-中度狭窄病变)。所有病例采用冠脉造影数字跟踪技术测定LAD平均血流速度(CFVm),其中15例用冠脉造影TIMI计帧法测定LAD血流速度(帧.f)。另15例使用Doppler导丝测定LAD平均峰值血流速度(APV),并与CFVm作相关分析。结果冠脉造影数字跟踪法测定LAD的CFVm(18.58±6.46)与Doppler导丝测得的LAD近端(17.42±5.99)和远端(17.93±5.78)的APV显著相关(r=0.79.r=0.64);而与TIMI计帧法血流速度呈弱相关(r=-0.47)。PCI治疗成功后,随着狭窄最小腔径增加,跟踪法血流速度加快(P<0.01),CFVm≥20cm/s。结论冠脉造影数字跟踪技术测定冠脉血流速度与Doppler血流速度显著相关,两者表达单位一致,方法简便易行,重复性好,可以用作常规冠脉造影血流速度定量指标。     

冠脉造影脉冲响应分析评价心肌微循环

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。     

冠脉造影脉冲响应原理评价心肌微循环

本方法采用冠脉造影脉冲响应原理,建立冠脉造影心肌微循环分析系统。结合定量冠脉造影(QCA),该系统提供有关心肌微循环(Tmicro-1)、冠脉几何形态(MLD)和血流动力学(mAP、CFV、Rcor)等定量指标,用以评价冠状动脉和心肌微循环,并临床应用20例。结果显示:随着近段冠脉狭窄MLD缩小,Tmicro-1减少;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),并且CFV、Rcor均得到一致改善。因此,冠脉造影脉冲响应分析系统所提供的Tmicro-1、CFV等定量分析指标,可作为评估冠脉血流和心肌微循环功能状态的敏感参数,结合定量冠脉造影分析指标,有利于提高常规冠脉造影解剖形态与生理功能相结合,分析冠脉狭窄和介入治疗前、后心肌微循环和大-小循环动力学之间的变化关系。     

冠脉轻度狭窄患者内皮功能和冠脉血流储备的临床观察

目的:观察冠脉轻度狭窄患者血管内皮功能和冠脉血流储备(CFR)的变化。方法:常规冠脉造影显示冠脉狭窄<50%患者56例,根据冠脉内注射乙酰胆碱(Ach)反应结果分为Ach阳性组与阴性组;运用数字跟踪技术软件测算两组患者CFR,并采血检测超敏C-反应蛋白(hs-CRP)水平。结果:Ach阳性组CFR低于阴性组(P<0.05),hs-CRP高于阴性组(P<0.01)。结论:早期冠心病患者存在内皮功能异常且伴有CFR降低。     

冠状造影脉冲响应分析评价心肌微循环

目的探讨冠脉造影脉冲响应分析评价心肌微循环的价值。方法数字血管造影脉冲响应函数分析系统 ,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),作为评价局部心肌微循环灌注指标。结合定量冠脉造影(QCA)、计算机测量冠脉血流速度并计算冠脉血流动力学参数来评价冠脉狭窄和介入治疗前、后心肌微循环和大小循环动力学之间的变化关系。结果随着近段冠脉狭窄MLD缩小 ,Tmicro-1 减少 ;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临床指标 ;急性冠脉综合征PCI治疗后 ,随着狭窄MLD增加 ,Tmicro-1 和CFV、Rcor均得到一致改善 ,但PCI前Tmicro-1 与CFV之间并非线性相关(r=0.18,P>0.05) ,可能与大、小循环之间存在不同的影响因素有关 ,但Tmicro -1更能反应局部心肌灌注。结论QCA结合Tmicro -1、CFV等定量指标 ,有利于提高常规冠脉造影解剖形态与生理功能相结合、大(体循环)、小(微循环)循环相关联的综合诊断水平     

冠心病患者FFA水平与冠脉病变程度的相关性分析

目的 探讨冠心病(CHD)患者游离脂肪酸(FFA)水平与冠脉病变程度的关系.方法 选取我院接诊的具备完整病例资料的433例CHD患者为研究对象,另纳入我院同期健康体检者90例为对照组,比较不同类型、冠脉不同狭窄支数和不同冠脉病变Gensini积分CHD患者的FFA水平,分析FFA与冠脉病变程度的相关性.结果 CHD组与对照组甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、载脂蛋白A1(APOA1)、FFA比较,差异均有统计学意义(P<0.05),不稳定型心绞痛(UAP)、稳定型心绞痛(SAP)和急性心肌梗死(AMI)组FFA水平均显著高于对照组(P<0.05),UAP组和SAP组FFA水平比较,差异无统计学意义(P>0.05);AMI组FFA水平显著高于UAP组和SAP组(P<0.05);FFA水平随着冠脉狭窄支数和冠脉病变Gensini积分的增加而升高(P<0.05);FFA水平与冠脉病变Gensini积分呈正相关(r=0.309,P<0.05);FFA水平与冠脉狭窄支数呈正相关(r=0.265,P<0.05);FFA>0.57mmol/L是冠脉病变的独立危险因素.结论 CHD患者FFA水平与冠脉病变Gensini积分、冠脉狭窄支数呈正相关,FFA>0.57mmol/L是冠脉病变的独立危险因素,治疗过程中应监测和控制FFA水平.     

冠脉生理学检测技术发展2021年研究进展

心血管疾病是危害人类生命健康最严重的疾病之一,中国每5人中就有2人死于心血管疾病。心肌缺血是重要的心血管疾病之一。心肌血流储备分数(fractional flow reserve, FFR)用于量化心外膜下冠状动脉狭窄是否产生心肌缺血;微血管阻力指数(index of microcirculatory resistance, IMR)是定量评价冠脉微循环状态的有创指标。传统FFR和IMR测量临床上依靠导丝,在最大充血态下进行介入测量,临床上辅助心肌缺血的诊断。基于冠脉造影的caFFR和caIMR(coronary angiography-derived FFR and IMR)无需介入操作、无需血管扩张药物、无禁忌症限制,可以快速同步计算FFR和IMR,进而辅助冠脉介入手术的诊疗。本文总结了近年来基于冠脉造影的caFFR和caIMR以及其他冠脉生理学检测技术的研究进展。进一步开展基于造影的FFR和IMR组合研究,从宏观到微观开展冠脉功能学研究具有重要的临床价值。     

心肌桥对冠状动脉血流储备的影响

目的评价心肌桥患者冠状动脉受压迫时冠脉血流储备的影响。方法11例冠脉造影显示心肌桥患者运用冠脉内多普勒检查即刻测定冠脉前降支的血流储备与28例冠脉造影正常的对照组进行比较。结果两组患者一般情况无差异,11例心肌桥患者均有心绞痛病史,心肌桥均位于前降支(中段8例、中远段3例),收缩期及舒张期冠脉狭窄分别为(79.3±7)%和(13.7±3)%,血流储备较对照组明显降低(2.1±0.5和3.6±0.7,P<0.01)。结论心肌桥患者血流储备降低可能是患者心绞痛的主要原因。     

冠脉微血管病变的临床特点与防治

近几年的研究证明，冠状动脉血流储备(CFR)功能与冠脉微循环有密切的关系。例如，积极的冠脉再通治疗使急性冠脉综合征的预后大大改观，但冠脉血流储备的恢复仍不理想；积极的抗高血压治疗虽能减低总死亡率，但对致命性心肌梗塞却几乎没有影响，且合并心肌肥厚者更易     

冠状动脉慢血流患者危险因素分析

目的:回顾性分析冠状动脉慢血流(CSF)患者的相关危险因素。方法:纳入2015-01—2016-09于本院行冠脉造影检查未见明显狭窄患者307例,采用校正的TIMI(Thrombolysis in Myocardial Infarction)血流分级方法将其分为CSF组(n=183)和正常对照组(n=124),比较两组间临床和实验室指标,对有差异者进行多因素Logistic回归分析CSF危险因素,同时分析有关指标与慢血流冠脉支数的相关性。结果:CSF组的男性比例、吸烟比例,血红蛋白(HGB)、红细胞压积(HCT)和血肌酐(SCr)水平均明显高于对照组(P0.05)。Logistic回归分析显示,较高HCT(OR=1.083,95%CI 1.020-1.150,P=0.009)和男性(OR=1.857,95%CI 1.074-3.213,P=0.027)为CSF的独立危险因素。Spearman相关分析表明男性以及HCT和HGB水平与CSF冠脉支数均呈非常显著正相关。结论:男性激素及较高的HCT水平可能参与CSF的病理生理过程。     

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。     

双源CT冠脉成像对冠状动脉畸形的诊断价值

目的：探讨双源CT（DSCT）冠脉成像在冠状动脉畸形（CAA）诊断中的价值。方法：回顾分析357例经DSCT冠脉成像检出的冠状动脉畸形患者的MPR、VR、MIP及CPR图像,其中31例患者的图像与常规冠状动脉血管造影（CAG）进行对照。结果：DSCT冠脉成像检出的357例冠状动脉畸形中,冠状动脉起源异常37例,包括冠状动脉高位起源15例,冠状动脉起源于对侧冠状窦13例,回旋支起自左冠状窦7例,回旋支起自右冠状窦1例,单一冠状动脉1例;本组冠状动脉走行异常均表现为心肌桥（MB）,其发现MB319例326处;冠状动脉终止异常中冠状动脉瘘1例。其中31例于DSCT冠脉造影后行CAG检查,DSCT冠脉成像检出27例29处MB者CAG仅检出21例22处,但3例冠状动脉起源异常及1例冠状动脉瘘行CAG全部检出。结论：DSCT冠脉成像能清晰地显示各种冠状动脉畸形,为术前评估及预后判断提供重要信息,亦可作为随诊复查的可靠方法。     

Technical achievement: transthoracic Doppler echocardiography can be used to detect LAD restenosis after coronary angioplasty.

We investigated the capability of transthoracic Doppler echocardiography (TTE) to detect and quantify the severity of restenosis in the left anterior descending coronary artery (LAD) after percutaneous transluminal coronary angioplasty (PTCA). We studied 10 consecutive patients assigned for quantitative coronary angiography (qCA) due to a recurrent angina pectoris after PTCA of the LAD. The LAD was visualized by TTE, and the presence of local turbulence and an increase in the blood flow velocity was regarded to indicate coronary stenosis. To assess the severity of the stenosis, the increase of blood flow velocity was measured. Angiography showed stenoses of various degrees (27-100%) in all patients. All stenoses were detectable using TTE. Moreover, the ratio of maximal blood flow velocity at the site of stenosis to the pre-stenotic blood flow velocity (M/P-ratio) correlated significantly with the reduction of the luminal diameter of LAD (r = 0.85, P < 0.003). A M/P-ratio higher than 3.0 predicted a diameter reduction of 50% or higher with sensitivity and specificity of 100% in patients with a subtotal stenosis (n = 9). Our results indicate that stenoses in the LAD could be found and the severity of the stenoses could be quantified reliably with TTE. This approach is totally non-invasive and less expensive than coronary angiography and can be used clinically in clarifying restenosis after coronary angioplasty.     

Coronary flow reserve: measurement with transthoracic Doppler echocardiography is reproducible and comparable with positron emission tomography.

Detection of early vascular changes indicated by lowered coronary flow reserve (CFR) would allow early treatment and prevention of atherosclerosis. The purpose of this study was to test whether it is possible to reproducibly measure CFR with transthoracic Doppler echocardiography (TTE) in healthy volunteers. We measured CFR using dipyridamole infusion in ten healthy male volunteers with two methods: TTE and positron emission tomography (PET) with oxygen-15-labelled water (group A). However, CFR was assessed twice with TTE in eight healthy male volunteers (group B) to study the reproducibility of this method. We compared CFRs obtained using TTE flow measurements in the left anterior descending coronary artery (LAD) and PET flow measurements in the corresponding myocardial area. Coronary flow in LAD could be measured in all subjects using TTE. By TTE, an average CFR based on peak diastolic flow velocity (PDV) was 2.72 +/- 1.16, mean diastolic flow velocity (MDV) 2.56 +/- 1.06 and velocity time integral (VTI) 1.87 +/- 0.49. The results were reproducible in two repeated TTE studies (coefficient of variation in MDV 6.1 +/- 4.3%, n=8). By PET, CFR was 2.52 +/- 0.84. CFR assessed by TTE correlated closely with that measured by PET (MDV r=0.942, P<0.001; PDV r=0.912, P<0.002 and VTI r=0.888, P<0.006) and intraclass correlation was 0.929 (MDV) and tolerance limits for differences of CFRs was -0.78 to 0.72. We show that CFR measured by TTE has an excellent correlation with CFR measured by PET. We also found that TTE measurements of CFR were highly reproducible.     

Non-invasive evaluation of the conduit function and the buffering function of large arteries in man.

The purpose of this study was to validate a two-dimensional (2D) echography coupled range-gated Doppler system for the non-invasive measurement of internal diameter, blood flow velocity, and pulse wave velocity of peripheral arteries, such as the common carotid artery (CCA), femoral artery (FA), and brachial artery (BA) in man. The array of the ultrasonic system and the Doppler probe were attached and formed a fixed angle (38 degrees 30'). The artery was firstly visualized using the echo-graphic array probe in order to position the Doppler beam. Then, the range-gated Doppler system was used to measure both internal diameter and blood flow velocity with the sample volume position covering the internal diameter. Using a hydraulic device, there was an obvious correlation between the calculated and the measured velocities (r = 0.98). Normal values of diameter, blood flow velocity and blood flow were measured in 18 healthy volunteers. The means (+/- 1 standard deviation) was as follows: diameter, CCA = 0.636 +/- 0.027 cm, FA = 0.843 +/- 0.074 cm, BA = 0.302 +/- 0.052 cm; flow velocity, CCA = 19.5 +/- 2.1 cm s-1, FA = 11.4 +/- 1.2 cm s-1, BA = 6.7 +/- 1.0 cm s-1. Blood flows were as follows: CCA, 370.6 +/- 42.5 ml mn-1, FA 387.0 +/- 75.0 ml mn-1 and BA (wrist occlusion) 29.8 +/- 12.5 ml mn-1. The intra-observer reproducibilities for CCA, FA and BA were respectively: for diameter, 4.9%, 4.12% and 14.8%; for velocity, 8.9%, 10.6% and 10.2%. The inter-observer reproducibilities were respectively: for diameter, 5.6%, 5.4% and 11.3% for velocity, 6.5%, 5.7% and 6.3%. Simultaneous determinations of pulse wave velocity from blood flow velocity recording allowed estimations of the distensibility of these arteries. Finally, the coupled echo and range-gated Doppler system permitted non-invasive evaluation of blood flow calculated as the product of the vessel cross-sectional area and measured blood velocity and also of arterial compliance as the ratio of the cross-sectional area and the square of pulse wave velocity. Such estimations of the conduit and buffering functions of peripheral large arteries in man were shown to be more accurate for the common carotid and the femoral arteries than for the brachial artery.     

Assessment of coronary flow reserve with transthoracic Doppler echocardiography: comparison with intracoronary Doppler method

To evaluate the feasibility and usefulness of transthoracic Doppler echocardiography (TTDE) as a non-invasive method in recording distal anterior descending (LAD) coronary flow velocity, we compared coronary flow reserve (CFR) measured by TTDE with measurements by intracoronary Doppler wire (ICDW). Twenty-one patients without LAD stenosis were studied. ICDW performed at baseline and after intracoronary injection of 18 microg adenosine. TTDE was performed at baseline and after intravenous adenosine (140 microg/kgmin for 2 min). Adequate Doppler recordings of coronary flow velocities during systole were obtained in 14 of 21 study patients (67%) and during diastole in 17 (81%) patients. Baseline and hyperemic peak diastolic flow velocities measured by TTDE were significantly smaller than those obtained by ICDW (p<0.05). However, diminishing trends of diastolic and systolic velocity ratio after hyperemia were similarly observed in both methods. CFR obtained by TTDE (3.0+/-0.5), was higher than the value calculated by ICDW (2.5+/-0.4). There were significant correlations between the values obtained by the two methods (r=0.72, p<0.01). It is concluded that TTDE is a feasible method in measuring coronary flow velocity and appears to be a promising non-invasive method in evaluating CFR.     

Ovarian stromal blood flow changes after laparoscopic ovarian cauterization in women with polycystic ovary syndrome

BACKGROUND: Women with PCOS have significant differences in intra-ovarian and uterine artery haemodynamics. The aims of this study were to compare the ovarian stromal blood flow before and after laparoscopic ovarian diathermy, and to evaluate the value of these parameters in predicting the outcome of treatment in women with polycystic ovaries. METHODS: Colour Doppler blood flow within the ovarian stroma was recorded and serum concentrations of FSH, LH and testosterone were measured in 52 women with polycystic ovaries before and after laparoscopic ovarian diathermy. Ovulation was evaluated by folliculometry and progesterone assay in the first menstrual cycle after operation. RESULTS: Six to 10 weeks after the diathermy, serum concentrations of LH and testosterone decreased significantly (P = 0.001). The mean +/- SD peak systolic velocity decreased from 14.04 +/- 6.28 to 12.49 +/- 6.32 cm/s (P = 0.001), pulsatility index increased from 0.98 +/- 0.36 to 1.78 +/- 0.72 (P = 0.001), and resistance index increased from 0.55 +/- 0.16 to 0.71 +/- 19 (P = 0.001). A total of 73% of the women ovulated. There were significant negative correlations between pulsatility index and LH (r = -0.43, P = 0.001), pulsatility index and testosterone (r = -0.40, P = 0.003) and pulsatility index and LH/FSH ratio (r = -0.53, P = 0.001). CONCLUSIONS: Laparoscopic ovarian diathermy in women with polycystic ovary syndrome may result in a decrease in ovarian stromal blood flow velocity. There was a significant correlation between hormonal and ovarian stromal blood-flow changes. Changes in the Doppler parameters were significantly higher in women who ovulated. The measurement of ovarian stromal blood flow by colour Doppler may be of value in predicting the outcome of treatment.     

盐酸法舒地尔对心绞痛患者冠状动脉慢血流的疗效

目的:观察盐酸法舒地尔治疗冠状动脉慢血流(CSFP)心绞痛的疗效。方法:将72例冠状动脉造影发现CSFP的心绞痛患者随机分为观察组和对照组,每组36例,均给予心绞痛常规治疗,观察组在常规治疗基础上静脉滴注盐酸法舒地尔60mg,1次/天,每月治疗10天,连续3个月。3个月后复查冠脉造影TIMI血流并观察心绞痛缓解情况,比较两组差异。结果:观察组心绞痛改善总有效率88.89%,与对照组(72.22%)相比,差异无统计学意义(P>0.05);观察组治疗前后TIMI计帧值(25.63±4.02 vs 31.67±5.32)差异有统计学意义(P<0.05),而对照组(30.73±5.14 vs 32.05±8.02)无明显差异(P>0.05)。观察期间未发现不良反应。结论:盐酸法舒地尔可改善CSFP并缓解心绞痛症状。     

冠脉钙化与冠脉血管病变严重程度的相关性分析

目的 探讨冠状动脉钙化与冠脉血管病变严重程度的相关性。方法 回顾性分析2017年1月~2018年7月我院收治的经256层螺旋CT检查并于30 d内行选择性冠脉造影（CAG）检查的疑似冠心病患者51例的相关资料。统计多层螺旋CT扫描的患者冠脉钙化总积分。应用Spearman秩相关分析进行冠脉钙化与冠脉病变的相关性。结果 51例患者钙化积分为0~2645.6分,平均钙化积分为（285.66±420.87）分,其中钙化积分为0分的患者有6例（11.80%）。Spearman秩相关分析显示,钙化积分与反映冠脉病变严重程度的变量冠脉狭窄病变≥50%的病变支数、冠脉狭窄病变≥50%的血管节段数、冠脉狭窄病变≥75%的血管节段数呈相关程度较弱的正相关（r=0.291~0.319,P＜0.05）;钙化积分与Gensini积分无相关性（r=0.264,P＞0.05）。钙化积分与年龄无相关性（r=0.253,P＞0.05）。结论 冠脉钙化总积分与冠脉病变的严重程度呈相关较弱的非线性正相关,冠脉钙化程度较难预测冠脉病变的狭窄程度。