Citro Rodolfo, Voci Paolo, Pizzuto Francesco, Maione Anton Giulio, Patella Marco Mariano, Bossone Eduardo, Provenza Gennaro, Gregorio Giovanni, Mariano Enrica, Feinstein Matthew, Athanassopoulos Georgeos, Puddu Paolo Emilio
San Luca Hospital, Vallo della Lucania, Salerno, Italy.
J Cardiovasc Med (Hagerstown). 2008 Dec;9(12):1254-9. doi: 10.2459/JCM.0b013e328312954e.
Transthoracic Doppler echocardiography is a valuable tool to measure coronary flow reserve (CFR) and detect in-stent restenosis (ISR) after percutaneous coronary angioplasty in selected series of patients.
To assess the usefulness of coronary flow reserve measured by echocardiography in detecting significant (> or =70%) ISR of the left anterior descending coronary artery in a large unselected population.
Two hundred and twenty-three patients (age 61 +/- 10 years; 168 men) treated with left anterior descending stenting underwent CFR measurement by transthoracic Doppler echocardiography and venous adenosine infusion 24-72 h before control coronary angiography. Coronary-active drugs were continued, and patients with multiple risk factors and old anterior-apical myocardial infarction were included.
Significant ISR occurred in 56 patients (25%). Patients with ISR had higher basal coronary flow velocity (27 +/- 10 cm/s vs. 24 +/- 7 cm/s; P < 0.002) and lower CFR (1.5 +/- 0.5 vs. 2.7 +/- 0.6; P < 0.0001) than those without ISR. A linear relation was found between ISR and CFR (r = -0.73; P < 0.0001) and remained significant after adjustment for blood pressure and heart rate (r = -0.74; P < 0.0001). A CFR less than two identified significant ISR (sensitivity 88%, specificity 88%, area under the curve = 0.943; P < 0.001). In a multivariate model of CFR prediction, myocardial infarction and heart rate were slightly contributory (ss = -0.19, P < 0.01; ss = -0.16, P < 0.03, respectively), whereas ISR had a large influence (ss = -0.66; P < 0.0001). The inverse correlation between ISR and CFR persisted in patients with myocardial infarction (r = -0.64; P < 0.0001) and in those treated with beta-blockers (r = -0. 71; P < 0.0001).
Echocardiographic measurement of CFR detects significant left anterior descending ISR in unselected patients with multiple risk factors, old anterior-apical myocardial infarction, and taking beta-blockers.
经胸多普勒超声心动图是测量冠状动脉血流储备（CFR）以及在特定患者系列中检测经皮冠状动脉成形术后支架内再狭窄（ISR）的一种有价值的工具。
评估在一大群未经挑选的人群中，通过超声心动图测量的冠状动脉血流储备在检测左前降支冠状动脉严重（≥70%）支架内再狭窄方面的有用性。
223例接受左前降支支架置入术的患者（年龄61±10岁；168例男性）在对照冠状动脉造影前24 - 72小时，通过经胸多普勒超声心动图和静脉注射腺苷进行冠状动脉血流储备测量。继续使用冠状动脉活性药物，纳入有多种危险因素和陈旧性前壁 - 心尖部心肌梗死的患者。
56例患者（25%）发生严重支架内再狭窄。与无支架内再狭窄的患者相比，有支架内再狭窄的患者基础冠状动脉血流速度更高（27±10 cm/s对24±7 cm/s；P < 0.002），冠状动脉血流储备更低（1.5±0.5对2.7±0.6；P < 0.0001）。发现支架内再狭窄与冠状动脉血流储备之间存在线性关系（r = -0.73；P < 0.0001），在调整血压和心率后仍具有显著性（r = -0.74；P < 0.0001）。冠状动脉血流储备小于2可识别严重支架内再狭窄（敏感性88%，特异性88%，曲线下面积 = 0.943；P < 0.001）。在冠状动脉血流储备预测的多变量模型中，心肌梗死和心率的贡献较小（标准化回归系数分别为 -0.19，P < 0.01； -0.16，P < 0.03），而支架内再狭窄有较大影响（标准化回归系数 = -0.66；P < 0.0001）。支架内再狭窄与冠状动脉血流储备之间的负相关在心肌梗死患者（r = -0.64；P < 0.0001）和接受β受体阻滞剂治疗的患者（r = -0.71；P < 0.0001）中持续存在。
超声心动图测量冠状动脉血流储备可在有多种危险因素、陈旧性前壁 - 心尖部心肌梗死且正在服用β受体阻滞剂的未经挑选的患者中检测到严重的左前降支支架内再狭窄。
