[冠状动脉阻力系统在冠状动脉内微栓塞后微血管功能障碍评估中的应用：一项实验研究]

Zhang Liang-hui, Ge Jun-bo, Qian Ju-ying, Zhang Qing-yong, Luo Zhong-chi, Wang Yuan-yuan, Cai Nai-sheng, Wang Wei-qi

Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China.

Zhonghua Yi Xue Za Zhi. 2004 Apr 2;84(7):578-82.

OBJECTIVE

To assess the microvascular function of coronary artery after intracoronary microembolization using coronary resistance system.

METHODS

The left anterior descending coronary artery (LAD) of 10 pigs weighing 21 kg-25 kg were embolized by repetitive injection of microspheres 45 micro m in diameter through a 2.8F Tracker catheter. Intra-vascular ultrasound (IVUS) images, intracoronary Doppler and pressure signals in the middle segment of LAD were acquired by use of intracoronary ultrasound imaging catheter, Doppler flow wire and pressure wire separately. Intracoronary bolus injection of 18 micro g adenosine was administered to maximally vasodilate the coronary arterial bed through the 2.8F Tracker catheter. The resting and hyperemic signals were acquired respectively before microembolization and in different levels of microembolization. Coronary resistance system reflecting the resistance to pulsatile coronary flow was established by a self-made software of PC system. The resting and hyperemic CR parameters included average resting coronary resistance (rCR) and average minimal coronary resistance (min-CR), the first-harmonic rCR and min-CR, the first-harmonic rCR orientation and min-CR orientation, and so on. Factor analysis was performed to extract the best coronary parameter from the coronary resistance parameters.

RESULTS

Factor analysis showed that the first-harmonic rCR and first-harmonic min-CR were correlated better with the first component extracted from the resting and hyperemic CR parameters than rCR and min-CR, with the correlation coefficient being 0.913 and 0.950 in the first-harmonic CR and first-harmonic min-CR respectively. No significant difference in min-CR was found between the value at the dosage of 5 x 10(4) microspheres and that before microembolization. The min-CR value increased markedly from 271 mm Hg.ml(-1).s(-1) +/- 99 mm Hg.ml(-1).s(-1) at the dosage of injecting 5 x 10(4) microspheres to 361 mm Hg.ml(-1).s(-1) +/- 158 mm Hg.ml(-1).s(-1) at the dosage of injecting 10 x 10(4) microspheres (P < 0.05). The min-CR value remained almost unchanged from the dosage of 10 x 10(4) to 15 x 10(4) microspheres. There was no significant difference concerning the first-harmonic min-CR between the value at the dosage of 5 x 10(4) microspheres and that before microembolization. Along with the increase of number of microspheres injected the min-CR value increased gradually. The min-CR value was increased significantly than that before microembolization since the number of microspheres injected surpassed 14 x 10(4).

CONCLUSION

The first-harmonic min-CR reflected the coronary microvascular dysfunction in different extents of microembolization better than min-CR. The extent of coronary microvascular dysfunction wasn't linearly related to the extent of microembolization.

目的

使用冠状动脉阻力系统评估冠状动脉内微栓塞后冠状动脉的微血管功能。

方法

对10头体重21 kg - 25 kg的猪，通过2.8F Tracker导管反复注射直径45μm的微球栓塞左前降支冠状动脉（LAD）。分别使用冠状动脉内超声成像导管、多普勒血流导丝和压力导丝获取LAD中段的血管内超声（IVUS）图像、冠状动脉内多普勒和压力信号。通过2.8F Tracker导管冠状动脉内推注18μg腺苷，以使冠状动脉床最大程度地扩张。在微栓塞前和不同程度微栓塞时分别获取静息和充血信号。通过自制的PC系统软件建立反映冠状动脉搏动血流阻力的冠状动脉阻力系统。静息和充血CR参数包括平均静息冠状动脉阻力（rCR）和平均最小冠状动脉阻力（min-CR）、一次谐波rCR和min-CR、一次谐波rCR方向和min-CR方向等。进行因子分析以从冠状动脉阻力参数中提取最佳冠状动脉参数。

结果

因子分析表明，一次谐波rCR和一次谐波min-CR与从静息和充血CR参数中提取的第一成分的相关性比rCR和min-CR更好，一次谐波CR和一次谐波min-CR的相关系数分别为0.913和0.950。在注射5×10⁴个微球时的min-CR值与微栓塞前相比无显著差异。min-CR值从注射5×10⁴个微球时的271 mmHg·ml⁻¹·s⁻¹±99 mmHg·ml⁻¹·s⁻¹显著增加到注射10×10⁴个微球时的361 mmHg·ml⁻¹·s⁻¹±158 mmHg·ml⁻¹·s⁻¹（P < 0.05）。从注射10×10⁴个微球到15×10⁴个微球时，min-CR值几乎保持不变。在注射5×10⁴个微球时的一次谐波min-CR值与微栓塞前相比无显著差异。随着注射微球数量的增加，min-CR值逐渐升高。自注射微球数量超过14×10⁴个后，min-CR值比微栓塞前显著升高。