应用血管内多普勒超声评价主动脉瓣返流对冠状动脉血流的影响

目的应用血管内多普勒超声评价主动脉瓣返流对冠状动脉血流的影响。方法选取慢性重度的主动脉瓣返流患者12例,先行冠状动脉造影检查,排除冠心病,再行冠状动脉内多普勒检查,测定前降支中远端的平均峰值流速(APV),舒张收缩流速比值(DSVR),冠状动脉血流储备(CFR)等,并测定左心室舒张末压力(LVEDP),用12例正常数据作对照。结果与正常对照相比,主动脉瓣返流患者 APV 升高(45.8±19.5)cm/s vs.(23.5±15.4)cm/s,P<0.05];DSVR 降低(1.4±0.8)vs.(2.6±1.7),P<0.05];CFR 降低(1.5±1.9)cm/s vs.(3.8±2.1)cm/s,P<0.05];LVEDP 升高(20.6±10.5)mm Hg(1 mm Hg=0.133 kPa)vs.(8.2±5.6)mm Hg,P<0.05];前降支中段内径无变化(3.8±1.5)mm us.(3.5±1_4)mm,P>0.05]。结论慢性重度主动脉瓣返流对冠状动脉血流有显著影响,表现为基础状态时 APV 升高,而 DSVR 和 CFR 降低,并使左心室舒张功能减低。CFR减低可能是冠状动脉造影正常的主动脉瓣返流患者心绞痛的主要机制。

Evaluation of coronary flow in patients with aortic regurgitation by intracoronary Doppler ultrasound

Objective To evaluate coronary flow reserve(CFR)in patients with severe aortic regurgitation(AR). Methods Intracoronary Doppler ultrasound was performed in 12 control subjects and 12 patients with AR.The average peak velocity(APV),diastolic systolic velocity ratio(DSVR)and CFR were recorded in the middle or distal part of the left anterior descending coronary artery(LAD).Left ventricular end diastolic pressure(LVEDP)were measured.Results Compared with control subjects,patients with AR,APV increased(45.8±19.5)cm/s vs. (23.5±15.4)cm/s,P<0.05];DSVR and CFR decreased significantly(1.4±0.8)vs.(2.6±1.7),P<0.05]and (1.5±1.9) cm/s vs.(3.8±2.1) cm/s,P<0.05]respectively;the internal diameter of LAD had no significant change(3.8±1.5)mm vs.(3.5±1.4)mm,P>0.05].Conclusions Coronary flow are impaired in patients with chronic severe AR.