Noto N, Karasawa K, Kanamaru H, Ayusawa M, Sumitomo N, Okada T, Harada K
Department of Paediatrics and Cardiology, Nihon University School of Medicine, Tokyo, Japan.
Heart. 2002 Jun;87(6):559-65. doi: 10.1136/heart.87.6.559.
To investigate whether transthoracic Doppler echocardiography (TTE) can reliably measure the coronary flow reserve in the left anterior descending coronary artery in children with Kawasaki disease.
Coronary flow velocity in the distal left anterior descending coronary artery was measured by TTE and was compared with that obtained by intracoronary Doppler guide wire. The ratio of maximum hyperaemia (intravenous administration of adenosine triphosphate, 160 microg/kg/min) to baseline peak (mean) diastolic coronary flow velocity in the distal artery was used as an estimate of coronary flow reserve.
University hospital.
10 patients with significant left anterior descending coronary stenosis (> 70% diameter stenosis) (group A) in the proximal or middle portion of the artery and 14 patients (group B) without significant stenosis, all with Kawasaki disease documented by previous coronary angiography.
The reduced hyperaemic coronary flow velocity in group A compared with group B resulted in a markedly lower coronary flow reserve, derived from both peak diastolic velocity and mean diastolic velocity by either technique of investigation. Multivariate analysis identified the best predictor of left anterior descending coronary artery stenosis to be a coronary flow reserve of < or = 2.2, derived from mean diastolic flow velocity measured using TTE (sensitivity 90%, specificity 100%, accuracy 96%). A good correlation was found between diastolic velocity derived values for coronary flow reserve measured using both TTE and Doppler guide wire (r = 0.92, p = 0.0001).
Coronary flow reserve in the distal left anterior descending coronary artery can be accurately measured using TTE without any intravascular instrumentation in children with Kawasaki disease.
探讨经胸多普勒超声心动图（TTE）能否可靠地测量川崎病患儿左前降支冠状动脉的血流储备。
采用TTE测量左前降支冠状动脉远端的血流速度，并与冠状动脉内多普勒导丝测得的结果进行比较。将最大充血状态（静脉注射三磷酸腺苷，160μg/kg/min）时远端动脉舒张期冠状动脉血流速度峰值与基线值的比值作为冠状动脉血流储备的评估指标。
大学医院。
10例左前降支冠状动脉近端或中段存在显著狭窄（直径狭窄>70%）的患者（A组）和14例无显著狭窄的患者（B组），所有患者均经先前冠状动脉造影证实患有川崎病。
与B组相比，A组充血状态下冠状动脉血流速度降低，导致两种检测技术测得的舒张期峰值速度和平均速度所衍生的冠状动脉血流储备均显著降低。多变量分析确定，左前降支冠状动脉狭窄的最佳预测指标是基于TTE测量的舒张期平均血流速度得出的冠状动脉血流储备≤2.2（敏感性90%，特异性100%，准确性96%）。使用TTE和多普勒导丝测得的舒张期速度衍生的冠状动脉血流储备值之间存在良好的相关性（r = 0.92，p = 0.0001）。
在川崎病患儿中，无需任何血管内器械，使用TTE即可准确测量左前降支冠状动脉远端的血流储备。
