Osório Altamiro Filho Ferraz, Tsutsui Jeane Mike, Kowatsch Ingrid, Guerra Vitor Coimbra, Ramires Jose Antônio Franchini, Lemos Pedro Alves, Cesar Luiz Antĉnio Machado, Mathias Wilson
Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil.
J Am Soc Echocardiogr. 2007 Jun;20(6):709-16. doi: 10.1016/j.echo.2006.11.016.
We sought to compare the feasibility and accuracy of myocardial blood flow reserve (MBFR) measured by quantitative real-time myocardial contrast echocardiography with those of coronary flow velocity reserve (CFVR) obtained by transthoracic Doppler echocardiography for detecting left anterior descending coronary artery (LAD) stenosis. We studied 71 patients who underwent adenosine stress contrast echocardiography, transthoracic Doppler echocardiography, and quantitative coronary angiography within 1 month. An index of myocardial blood flow (A x beta) was determined by quantification of peak plateau acoustic intensity (A) and microbubble replenishment velocity (beta) by contrast echocardiography. Feasibilities of qualitative analysis of myocardial perfusion, and CFVR and MBFR measurements were 98%, 83%, and 94%, respectively. Patients with LAD stenosis had lower CFVR (1.1 +/- 0.4 vs 2.7 +/- 0.8, P < .001), MBFR (1.2 +/- 0.5 vs 2.5 +/- 0.8, P < .001), and beta reserve (1.1 +/- 0.5 vs 2.4 +/- 0.6, P < .001) than those without lesion. Sensitivities, specificities, and accuracies for detecting LAD stenosis were 64%, 93%, and 80% for qualitative analysis of myocardial perfusion; 92%, 94%, and 93% for CFVR; 84%, 87%, and 86% for MBFR; and 80%, 97%, and 89% for beta reserve. In this selected study population, CFVR was the best index for detecting LAD stenosis (odds ratio = 1.78, 95% confidence interval = 1.28-2.47).
我们试图比较通过定量实时心肌对比超声心动图测量的心肌血流储备（MBFR）与经胸多普勒超声心动图获得的冠状动脉血流速度储备（CFVR）在检测左前降支冠状动脉（LAD）狭窄方面的可行性和准确性。我们研究了71例在1个月内接受腺苷负荷对比超声心动图、经胸多普勒超声心动图和定量冠状动脉造影的患者。通过对比超声心动图对峰值平台声学强度（A）和微泡补充速度（β）进行定量测定心肌血流指数（A×β）。心肌灌注定性分析、CFVR和MBFR测量的可行性分别为98%、83%和94%。LAD狭窄患者的CFVR（1.1±0.4 vs 2.7±0.8，P<.001）、MBFR（1.2±0.5 vs 2.5±0.8，P<.001）和β储备（1.1±0.5 vs 2.4±0.6，P<.001）低于无病变患者。检测LAD狭窄的敏感性、特异性和准确性，心肌灌注定性分析分别为64%、93%和80%；CFVR分别为92%、94%和93%；MBFR分别为84%、87%和86%；β储备分别为80%、97%和89%。在这个选定的研究人群中，CFVR是检测LAD狭窄的最佳指标（优势比=1.78，95%置信区间=1.28 - 2.47）。
