Takeuchi Masaaki, Ogawa Keitaro, Wake Ryotaro, Takise Hirohito, Miyazaki Chinami, Otani Shinichiro, Sakamoto Kazuo, Yoshikawa Junichi
Department of Internal Medicine, Tane General Hospital, 1-2-31 Sakaigawa, Nishi-ku, Osaka 550-0024 Japan.
J Am Soc Echocardiogr. 2004 Jan;17(1):21-7. doi: 10.1016/j.echo.2003.09.001.
Although the measurement of coronary flow velocity (CFV) reserve (CFVR) in the left anterior descending coronary artery (LAD) by transthoracic Doppler echocardiography has been established, its success rate in the posterior descending coronary artery (PD) is still limited.
This study reports the feasibility and diagnostic accuracy of measuring CFVR in the PD by transthoracic Doppler echocardiography.
CFVR in both the distal LAD and the PD was measured in 151 consecutive patients before coronary angiography. PD flow was investigated under the guidance of a nondirectional Doppler color flow map with harmonic imaging in the modified apical 2-chamber view. Intravenous contrast agent, Levovist, was injected to enhance the CFV envelope at baseline and during hyperemia.
CFVR was obtained in 145 patients in the LAD and 126 patients in the PD (P <.001). The success rate of CFVR measurement in the PD was significantly higher in the last 50 patients (88%) than it was in the first 50 patients (72%) (P <.05). CFVR in the PD was significantly lower for patients with significant stenosis of the artery supplying the PD than it was in those without stenosis (1.58 +/- 0.59 vs 2.45 +/- 0.72, P <.001). CFVR in the distal LAD was 1.40 +/- 0.62 in patients with significant LAD stenosis and 2.45 +/- 0.80 in those without stenosis (P <.001). If a cut-off value of CFVR < 2 was used, sensitivity, specificity, and accuracy for the diagnosis of significant (>50%) stenosis of the artery supplying the PD were 84%, 83%, and 83%, respectively, whereas for the LAD they were 91%, 75%, and 80%, respectively.
Noninvasive measurement of CFVR in the PD could be obtained in the majority of unselected patients using a nondirectional Doppler color flow map and contrast-enhanced harmonic imaging. The diagnostic accuracy of CFVR in the PD is similar to that of the LAD and, hence, has a potential clinical use.
虽然经胸多普勒超声心动图测量左前降支冠状动脉（LAD）的冠状动脉血流速度（CFV）储备（CFVR）已确立，但在右冠状动脉后降支（PD）的成功率仍然有限。
本研究报告经胸多普勒超声心动图测量PD中CFVR的可行性和诊断准确性。
在冠状动脉造影前，对151例连续患者测量LAD远端和PD中的CFVR。在改良的心尖两腔视图中，在非定向多普勒彩色血流图和谐波成像的引导下研究PD血流。静脉注射造影剂Levovist以增强基线和充血期间的CFV包络。
145例患者获得LAD中的CFVR，126例患者获得PD中的CFVR（P<.001）。在最后50例患者中，PD中CFVR测量的成功率（88%）显著高于前50例患者（72%）（P<.05）。供应PD的动脉有明显狭窄的患者，其PD中的CFVR显著低于无狭窄患者（1.58±0.59对2.45±0.72，P<.001）。LAD有明显狭窄的患者，其LAD远端的CFVR为1.40±0.62，无狭窄患者为2.45±0.80（P<.001）。如果使用CFVR<2的截断值，诊断供应PD的动脉明显（>50%）狭窄的敏感性、特异性和准确性分别为84%、83%和83%，而对于LAD，它们分别为91%、75%和80%。
使用非定向多普勒彩色血流图和对比增强谐波成像，大多数未经选择的患者可无创测量PD中的CFVR。PD中CFVR的诊断准确性与LAD相似，因此具有潜在的临床应用价值。
