Guarini Pasquale, Scognamiglio Giancarlo, Cicala Silvana, Galderisi Maurizio
Divisione di Cardiologia-UTIC, Ospedale Accreditato Villa dei Fiori, Acerra, NA.
Ital Heart J Suppl. 2003 Mar;4(3):179-88.
The assessment of coronary flow reserve with transthoracic Doppler echocardiography, measured as the ratio between hyperemic and baseline coronary flow velocities, is a new tool for the evaluation of coronary artery disease and coronary microcirculation. Color-guided pulsed Doppler allows almost optimal identification of flow velocities at the middle and distal left anterior descending artery and good visualization of the right coronary artery. The development of ultrasound technology (second harmonic, contrast agents, dedicated softwares) is responsible for great feasibility (until 98% for the left anterior descending artery and 40-50% for the right coronary artery) and very good reproducibility of this tool. Doppler-derived coronary flow reserve has excellent concordance with that obtainable with intravascular Doppler flow wire. Diagnosis of stenosis and restenosis after stent implantation in the middle and/or proximal left anterior descending artery and of stenosis of the right coronary artery is very accurate. In the absence of stenosis of epicardial coronary arteries, the reduction in coronary flow reserve implies a damage of coronary microcirculation, which can be a determinant of angina pectoris and signs of myocardial ischemia in arterial hypertension, diabetes mellitus and coronary X syndrome. Further progress may be expected by using myocardial contrast agents for quantitation of regional myocardial coronary flow reserve.
经胸多普勒超声心动图评估冠状动脉血流储备，以充血期与基础期冠状动脉血流速度之比来衡量，是评估冠状动脉疾病和冠状动脉微循环的一种新工具。彩色引导脉冲多普勒几乎能最佳地识别左前降支中、远端的血流速度，并能很好地显示右冠状动脉。超声技术（二次谐波、造影剂、专用软件）的发展使得该工具具有很高的可行性（左前降支可达98%，右冠状动脉为40 - 50%）和很好的可重复性。多普勒衍生的冠状动脉血流储备与血管内多普勒血流导丝获得的结果具有极好的一致性。对左前降支中、近端及右冠状动脉支架植入术后的狭窄和再狭窄诊断非常准确。在心外膜冠状动脉无狭窄的情况下，冠状动脉血流储备降低意味着冠状动脉微循环受损，这可能是动脉高血压、糖尿病和冠状动脉X综合征中心绞痛和心肌缺血征象的一个决定因素。使用心肌造影剂定量评估局部心肌冠状动脉血流储备有望取得进一步进展。
