Kataoka Yu, Nakatani Satoshi, Tanaka Norio, Kanzaki Hideaki, Yasuda Satoshi, Morii Isao, Kawamura Atsushi, Miyazaki Shunichi, Kitakaze Masafumi
Division of Cardiology, Department of Internal Medicine, National Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita 565-8565, Japan.
Circ J. 2007 Jun;71(6):891-6. doi: 10.1253/circj.71.891.
The assessment of patients with chest pain is an important step to make a diagnosis and clinical decision. Coronary flow reserve (CFR) can be used for the screening of significant coronary stenosis. However, the feasibility and limitation of CFR in those patients remains unknown.
A total of 100 patients with chest pain were examined. CFR was measured in all 3 major coronary arteries by using transthoracic Doppler echocardiography (TTDE). Coronary angiography was performed 1 to 3 days after TTDE. CFR in all 3 major coronary arteries could be measured in 83 (83%) of 100 patients. The echo-contrast agent was useful in 32 of 49 patients who had unclear color Doppler images. When CFR <2.0 was regarded as the cut-off point, the overall agreement rate between CFR and the results of coronary angiography was 83% (69 of the 83 patients). In addition, CFR could predict the presence of coronary artery disease satisfactorily (sensitivity 85%, specificity 81%, positive predictive value 89%, negative predictive value 93%).
TTDE seems to be a promising tool for screening patients with chest pain. Moreover, an echo-contrast agent seems to be an effective and supportive tool for patients who have poor visualization of coronary flow.
胸痛患者的评估是做出诊断和临床决策的重要步骤。冠状动脉血流储备（CFR）可用于筛查显著的冠状动脉狭窄。然而，CFR在这些患者中的可行性和局限性仍不清楚。
共检查了100例胸痛患者。使用经胸多普勒超声心动图（TTDE）测量了所有3支主要冠状动脉的CFR。在TTDE后1至3天进行冠状动脉造影。100例患者中有83例（83%）可测量所有3支主要冠状动脉的CFR。在49例彩色多普勒图像不清晰的患者中，32例使用了超声造影剂。以CFR<2.0为切点时，CFR与冠状动脉造影结果的总体符合率为83%（83例患者中的69例）。此外，CFR能够较好地预测冠状动脉疾病的存在（敏感性85%，特异性81%，阳性预测值89%，阴性预测值93%）。
TTDE似乎是筛查胸痛患者的一种有前景的工具。此外，超声造影剂似乎是冠状动脉血流显影不佳患者的一种有效辅助工具。
