Ascione Luigi, De Michele Mario, Accadia Maria, Granata Gianluca, Sacra Cosimo, D'Andrea Antonello, Guarini Pasquale, Tuccillo Bernardino
Division of Cardiology, S. Maria di Loreto Hospital, Naples, Italy.
Int J Cardiol. 2006 Jan 26;106(3):313-8. doi: 10.1016/j.ijcard.2005.01.053.
Coronary flow reserve (CFR) assessment by transthoracic Doppler echocardiography has been found to be useful in subjects with suspected coronary artery disease. An important clinical question is whether such technique can be successfully applied in patients admitted to the coronary care unit with an acute coronary syndrome to detect a significant left anterior descending (LAD) disease.
One hundred fifty-nine patients with acute coronary syndrome (93 patients with unstable angina, 66 with acute inferior or lateral myocardial infarction) were included in the present analysis. Patients underwent a high-dose dipyridamole stress (0.84 mg/kg) with combined assessment of CFR in the LAD and regional wall motion. Blood flow velocities were recorded in the mid-distal portion of the LAD using a digital ultrasonographic system and CFR was calculated as the ratio of hyperemia-induced peak diastolic velocity to resting peak diastolic flow velocity. All patients underwent coronary angiography and a significant LAD stenosis was classified for lumen narrowing > or = 70%.
Adequate Doppler recordings in the LAD were obtained in 92% of patients. A contrast agent was used in the 39% of examinations. No major adverse reaction occurred in any patient. A receiving operating characteristic curve showed that a CFR value < 1.9 had a sensitivity of 85%, a specificity of 87%, a positive predictive value of 71%, a negative predictive value of 94% and a diagnostic accuracy of 86% for identifying a significant LAD stenosis. The area under the receiving operating characteristic curve computed for CFR was significantly higher than for wall motion score index (p < 0.001). In a stepwise forward, multiple logistic regression analysis, both CFR (OR = 4.8, 95% C.I. 3.7-5.3; p < 0.00001) and the wall motion score index for the LAD territory (OR = 4.2, 95% C.I. 2.6-6.8; p < 0.0001) were independent determinants of LAD stenosis > or = 70%.
Early assessment of CFR by transthoracic Doppler echocardiography is feasible and safe and provides additional information to identify subjects with acute coronary syndrome and significant LAD stenosis.
经胸多普勒超声心动图评估冠状动脉血流储备（CFR）已被证明对疑似冠心病患者有用。一个重要的临床问题是，这种技术能否成功应用于因急性冠脉综合征入住冠心病监护病房的患者，以检测左前降支（LAD）的严重病变。
本分析纳入了159例急性冠脉综合征患者（93例不稳定型心绞痛患者，66例急性下壁或侧壁心肌梗死患者）。患者接受高剂量双嘧达莫负荷试验（0.84 mg/kg），同时评估LAD的CFR和局部室壁运动。使用数字超声系统记录LAD中远段的血流速度，CFR计算为充血诱导的舒张期峰值流速与静息舒张期峰值流速之比。所有患者均接受冠状动脉造影，LAD严重狭窄定义为管腔狭窄≥70%。
92%的患者获得了LAD的充分多普勒记录。39%的检查使用了造影剂。所有患者均未发生重大不良反应。受试者工作特征曲线显示，CFR值<1.9对于识别LAD严重狭窄的敏感性为85%，特异性为87%，阳性预测值为71%，阴性预测值为94%，诊断准确性为86%。CFR的受试者工作特征曲线下面积显著高于室壁运动评分指数（p<0.001）。在逐步向前多因素logistic回归分析中，CFR（OR=4.8，95%CI 3.7-5.3；p<0.00001）和LAD区域的室壁运动评分指数（OR=4.2，95%CI 2.6-6.8；p<0.0001）均为LAD狭窄≥70%的独立决定因素。
经胸多普勒超声心动图早期评估CFR是可行且安全的，并为识别急性冠脉综合征和LAD严重狭窄患者提供了额外信息。
