Aarnoudse Wilbert, Van't Veer Marcel, Pijls Nico H J, Ter Woorst Joost, Vercauteren Steven, Tonino Pim, Geven Maartje, Rutten Marcel, van Hagen Eduard, de Bruyne Bernard, van de Vosse Frans
Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands.
J Am Coll Cardiol. 2007 Dec 11;50(24):2294-304. doi: 10.1016/j.jacc.2007.08.047. Epub 2007 Nov 26.
This study sought to validate a new method for direct volumetric blood flow measurement in coronary arteries in animals and in conscious humans during cardiac catheterization.
Direct volumetric measurement of blood flow in selective coronary arteries would be useful for studying the coronary circulation.
Based on the principle of thermodilution with continuous low-rate infusion of saline at room temperature, we designed an instrumental setup for direct flow measurement during cardiac catheterization. A 2.8-F infusion catheter and a standard 0.014-inch sensor-tipped pressure/temperature guidewire were used to calculate absolute flow (Q(thermo)) in a coronary artery from the infusion rate of saline, temperature of the saline at the tip of the infusion catheter, and distal blood temperature during infusion. The method was tested over a wide range of flow rates in 5 chronically instrumented dogs and in 35 patients referred for physiological assessment of a coronary stenosis or for percutaneous coronary intervention.
Thermodilution-derived flow corresponded well with true flow (Q) in all dogs (Q(thermo) = 0.73 Q + 42 ml/min; R(2) = 0.72). Reproducibility was excellent (Q(thermo,)(1) = 0.96 x Q(thermo,)(2) + 3 ml/min; R(2) = 0.89). The measurements were independent of infusion rate and sensor position as predicted by theory. In the humans, a good agreement was found between increase of thermodilution-derived volumetric blood flow after percutaneous coronary intervention and increase of fractional flow reserve (R(2) = 0.84); reproducibility of the measurements was excellent (Q(thermo,)(1) = 1.0 Q(thermo,)(2) + 0.9 ml/min, R(2) = 0.97), and the measurements were independent of infusion rate and sensor position.
Using a suitable infusion catheter and a 0.014-inch sensor-tipped guidewire for measurement of coronary pressure and temperature, volumetric blood flow can be directly measured in selective coronary arteries during cardiac catheterization.
本研究旨在验证一种用于在动物以及清醒状态下接受心导管检查的人类冠状动脉中直接测量容积血流量的新方法。
选择性冠状动脉中血流量的直接容积测量对于研究冠状动脉循环具有重要意义。
基于在室温下持续低速率输注生理盐水的热稀释原理，我们设计了一种用于心导管检查期间直接流量测量的仪器装置。使用一根2.8F输注导管和一根标准的0.014英寸带有传感器的压力/温度导丝，根据生理盐水的输注速率、输注导管尖端处生理盐水的温度以及输注期间的远端血液温度来计算冠状动脉中的绝对流量（Q(thermo)）。该方法在5只长期植入仪器的犬以及35名因冠状动脉狭窄的生理评估或经皮冠状动脉介入治疗而转诊的患者中，在广泛的流量范围内进行了测试。
在所有犬中，热稀释法得出的流量与真实流量（Q）高度吻合（Q(thermo) = 0.73Q + 42 ml/min；R(2) = 0.72）。可重复性极佳（Q(thermo,)(1) = 0.96×Q(thermo,)(2) + 3 ml/min；R(2) = 0.89）。如理论预测的那样，测量结果与输注速率和传感器位置无关。在人类患者中，经皮冠状动脉介入治疗后热稀释法得出的容积血流量增加与血流储备分数增加之间存在良好的一致性（R(2) = 0.84）；测量的可重复性极佳（Q(thermo,)(1) = 1.0Q(thermo,)(2) + 0.9 ml/min，R(2) = 0.97），并且测量结果与输注速率和传感器位置无关。
使用合适的输注导管和一根0.014英寸带有传感器的导丝来测量冠状动脉压力和温度，在心导管检查期间可以直接测量选择性冠状动脉中的容积血流量。
