Kiviniemi Tuomas O, Toikka Jyri O, Koskenvuo Juha W, Saraste Antti, Saraste Markku, Pärkkä Jussi P, Raitakari Olli T, Hartiala Jaakko J
Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland.
Ultrasound Med Biol. 2007 Mar;33(3):362-70. doi: 10.1016/j.ultrasmedbio.2006.08.012.
Transthoracic Doppler echocardiography (TTE) has been introduced as a noninvasive tool to measure coronary flow velocity reserve (CFVR). Velocity measurement, however, fails to take into account epicardial coronary artery vasodilation during hyperemia and this may cause underestimation of CFVR measurements. Therefore, we sought to determine whether the vasodilation of epicardial coronary artery can be measured during cold pressor test (CPT) and adenosine infusion simultaneously with the flow velocity measurement using TTE. We studied 41 healthy nonsmoking men with a linear high-frequency 8.0-MHz transducer. The CPT and adenosine infusion dilated the diameter of the distal left anterior descending coronary artery (LAD) from 1.4 +/- 0.4 mm to 1.5 +/- 0.4 mm (14 +/- 13%, p < 0.01) and from 1.4 +/- 0.4 mm to 1.8 +/- 0.5 mm (31 +/- 19%, p < 0.01), respectively. The CPT increased flow velocity and calculated coronary blood flow rate (velocity time integral x cross-sectional area) from 0.23 +/- 0.05 m/s to 0.36 +/- 0.13 m/s (31 +/- 34%, p < 0.01) and from 8.1 +/- 4.2 mL/min to 11.4 +/- 6.0 mL/min (47 +/- 51%, p < 0.01). CFVR and calculated coronary blood flow rate reserve were 3.9 +/- 1.0 and 6.0 +/- 1.9, respectively. In Bland-Altman analysis, velocity measurements underestimated the vasodilation response of the CPT and adenosine compared with the measurements where epicardial diameter dilation was taken into account. Intra- and interobserver variability of diameter measurements was low (coefficient of variation [CV] 2.6 to 6.5%). Day-to-day, within-day and intersonographer variabilities were of similar magnitude (CV 4.6 to 8.2%), suggesting good reproducibility. This study demonstrates that TTE can be used to assess changes in both epicardial coronary artery diameter and flow velocity simultaneously in the distal LAD artery.
经胸多普勒超声心动图（TTE）已被用作测量冠状动脉血流储备（CFVR）的一种非侵入性工具。然而，速度测量未能考虑充血期间心外膜冠状动脉的血管舒张情况，这可能导致CFVR测量值被低估。因此，我们试图确定在冷加压试验（CPT）和腺苷输注过程中，能否使用TTE在测量血流速度的同时测量心外膜冠状动脉的血管舒张情况。我们使用线性高频8.0-MHz探头对41名健康不吸烟男性进行了研究。CPT和腺苷输注分别使左前降支冠状动脉（LAD）远端直径从1.4±0.4mm扩张至1.5±0.4mm（14±13%，p<0.01）和从1.4±0.4mm扩张至1.8±0.5mm（31±19%，p<0.01）。CPT使血流速度和计算得出的冠状动脉血流量（速度时间积分×横截面积）分别从0.23±0.05m/s增加至0.36±0.13m/s（31±34%，p<0.01）以及从8.1±4.2mL/min增加至11.4±6.0mL/min（47±51%，p<0.01）。CFVR和计算得出的冠状动脉血流量储备分别为3.9±1.0和6.0±1.9。在Bland-Altman分析中，与考虑心外膜直径扩张的测量相比，速度测量低估了CPT和腺苷的血管舒张反应。直径测量的观察者内和观察者间变异性较低（变异系数[CV]为2.6%至6.5%）。日间、日内和超声检查者间的变异性大小相似（CV为4.6%至8.2%），表明重复性良好。本研究表明，TTE可用于同时评估LAD动脉远端心外膜冠状动脉直径和血流速度的变化。
