Qian J, Ge J, Baumgart D, Oldenburg O, Haude M, Sack S, Erbel R
Department of Cardiology, Zhongshan Hospital, Shanghai Medical University, Shanghai, China.
Am Heart J. 2000 Sep;140(3):502-10. doi: 10.1067/mhj.2000.109221.
With the introduction of Doppler-tipped guide wires, intracoronary Doppler flow measurement has been increasingly accepted as an additional diagnostic approach in the catheterization laboratory. However, the safety of intracoronary Doppler flow measurement has not been well-investigated. The purpose of our study was to evaluate the safety of intracoronary Doppler flow measurement using the Doppler FloWire (Cardiometrics, Mountain View, Calif).
A total of 906 patients were examined by intracoronary Doppler with a 0.014-inch or an 0.018-inch Doppler FloWire. For coronary flow reserve measurement, intracoronary injection of adenosine or papaverine was used. Of the patients studied, 77 were cardiac transplant recipients and 829 were patients who had not received a transplant, of whom 617 had undergone diagnostic coronary procedures and 212 had coronary interventions. In 27 (2.98%) of 906 patients adverse cardiac events were observed. Fifteen (1.66%) of 906 patients had severe transient bradycardia develop (asystole or second- to third-degree atrioventricular block) after intracoronary administration of adenosine, 14 of which occurred in the right coronary artery and 1 in the left anterior descending artery. Nine (0.99%) of 906 patients had coronary spasm during the passage of the Doppler wire (5 in the right coronary artery, 4 in the left anterior descending artery). Two (0.22%) of 906 patients had ventricular fibrillation during the procedure. Hypotension with bradycardia and ventricular extrasystole each occurred in 1 (0.11%) of 906 patients. The incidence of complication was significantly higher in transplant recipients than in patients who underwent either diagnostic or interventional procedures (12.99% vs 2.43% vs 0.94%, P <.001). The Doppler measurements in the right coronary artery were associated with a higher incidence of complications, especially bradycardia, compared with the left anterior descending and the left circumflex arteries (right coronary, 5.87% vs left anterior descending, 1.05% vs left circumflex, 0.17%; P <.001). All complications were cured medically.
Intracoronary Doppler flow measurement with Doppler wires and intracoronary administration of adenosine is a safe method. However, severe complications such as bradycardia and coronary spasm can occur. Attention should be paid to the examination of the right coronary artery, especially in heart transplant recipients.
随着多普勒导丝的引入，冠状动脉内多普勒血流测量在导管室作为一种额外的诊断方法越来越被接受。然而，冠状动脉内多普勒血流测量的安全性尚未得到充分研究。我们研究的目的是评估使用多普勒血流导丝（Cardiometrics，加利福尼亚州山景城）进行冠状动脉内多普勒血流测量的安全性。
共有906例患者接受了冠状动脉内多普勒检查，使用的是0.014英寸或0.018英寸的多普勒血流导丝。对于冠状动脉血流储备测量，采用冠状动脉内注射腺苷或罂粟碱。在研究的患者中，77例是心脏移植受者，829例是未接受移植的患者，其中617例接受了诊断性冠状动脉检查，212例接受了冠状动脉介入治疗。在906例患者中，观察到27例（2.98%）发生不良心脏事件。906例患者中有15例（1.66%）在冠状动脉内注射腺苷后出现严重短暂性心动过缓（心脏停搏或二度至三度房室传导阻滞），其中14例发生在右冠状动脉，1例发生在左前降支动脉。906例患者中有9例（0.99%）在多普勒导丝通过期间发生冠状动脉痉挛（5例在右冠状动脉，4例在左前降支动脉）。906例患者中有2例（0.22%）在手术过程中发生心室颤动。低血压伴心动过缓和室性早搏各发生在906例患者中的1例（0.11%）。移植受者的并发症发生率显著高于接受诊断性或介入性手术的患者（12.99%对2.43%对0.94%，P<.001）。与左前降支动脉和左旋支动脉相比，右冠状动脉的多普勒测量与更高的并发症发生率相关，尤其是心动过缓（右冠状动脉，5.87%对左前降支动脉，1.05%对左旋支动脉，0.17%；P<.001）。所有并发症均经药物治愈。
使用多普勒导丝进行冠状动脉内多普勒血流测量及冠状动脉内注射腺苷是一种安全的方法。然而，可能会发生严重并发症，如心动过缓和冠状动脉痉挛。应注意对右冠状动脉的检查，尤其是在心脏移植受者中。
