Porenta G, Binder T, Moertl D, Zehetgruber M, Graf S, Maurer G, Probst P
Department of Cardiology, University of Vienna, Austria.
J Vasc Res. 2000 Nov-Dec;37(6):594-602. doi: 10.1159/000054093.
This study sought to delineate the impact of the rate pressure product on intraluminal Doppler velocity measurements and to determine the relation between poststenotic vasodilator reserve and percent luminal obstruction in coronary vessels. Twenty patients with single-vessel coronary disease were studied prior to coronary angioplasty and at follow-up 6 months later. Intracoronary velocity reserve after administration of adenosine was measured distal to the stenosis with a Doppler-tipped guide wire and was compared to quantitative coronary angiography and adenosine myocardial perfusion scintigraphy. The rate pressure product was confirmed as significant covariate (ANCOVA, p < 0.005) of intracoronary Doppler reserve. When normalized to rate pressure product, poststenotic Doppler velocity reserve in stenosed arteries was significantly lower than in patent arteries as classified by quantitative coronary angiography (1.7 +/- 0.6 vs. 2.9 +/- 0.5, p < 0.001) and perfusion scintigraphy (1.5 +/- 0.4 vs. 2.8 +/- 0.5, p < 0.001). Normalized Doppler velocity reserve showed a nonlinear but highly significant relation to percent area stenosis [y = 3.0.(1 - exp[0.081 (x - 100)]), p < 0.001]. When normalized Doppler velocity reserve was less than 2.0, coronary disease was identified with 95% specificity and 94% sensitivity in comparison to perfusion scintigraphy. Thus, in coronary arteries poststenotic Doppler reserve and percent area stenosis show a significant nonlinear relation. Doppler velocity reserve when normalized to rate pressure product can be used to characterize the hemodynamic impact of coronary obstructions.
本研究旨在阐明心率血压乘积对腔内多普勒速度测量的影响，并确定冠状动脉狭窄后血管扩张储备与管腔阻塞百分比之间的关系。对20名单支冠状动脉疾病患者在冠状动脉血管成形术前及6个月后的随访时进行了研究。使用带有多普勒探头的导丝在狭窄远端测量给予腺苷后的冠状动脉内速度储备，并与定量冠状动脉造影和腺苷心肌灌注闪烁显像进行比较。心率血压乘积被确认为冠状动脉内多普勒储备的显著协变量（协方差分析，p<0.005）。根据定量冠状动脉造影分类，当校正心率血压乘积后，狭窄动脉的狭窄后多普勒速度储备显著低于通畅动脉（1.7±0.6对2.9±0.5，p<0.001），灌注闪烁显像结果也类似（1.5±0.4对2.8±0.5，p<0.001）。校正后的多普勒速度储备与面积狭窄百分比呈非线性但高度显著的关系[y = 3.0.(1 - exp[0.081 (x - 100)]), p < 0.001]。当校正后的多普勒速度储备小于2.0时，与灌注闪烁显像相比，诊断冠心病的特异性为95%，敏感性为94%。因此，在冠状动脉中，狭窄后多普勒储备与面积狭窄百分比呈显著的非线性关系。校正心率血压乘积后的多普勒速度储备可用于描述冠状动脉阻塞的血流动力学影响。
