Ruzsa Zoltán, Pálinkás Attila, Forster Tamás, Ungi Imre, Varga Albert
Department of Medicine and Cardiology Center, Faculty of Medicine, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, H-6724, Szeged, Pécsi str, 4, Hungary.
Cardiovasc Ultrasound. 2011 Jun 14;9:19. doi: 10.1186/1476-7120-9-19.
the clinical decision making could be difficult in patients with borderline lesions (visually assessed stenosis severity of 30 to 50%) of the left main coronary artery (LM). The aim of the study was to evaluate the relationship between transthoracic Doppler (TTDE) peak diastolic flow velocity (PDV) and intravascular ultrasound (IVUS) measurements in the assessment of angiographically borderline LM lesions.
27 patients (mean age 64 ± 8 years, 21 males) with borderline LM stenosis referred for IVUS examination were included in the study. We performed standard IVUS with minimal lumen area (MLA) and plaque burden (PB) measurement and routine quantitative coronary angiography (QCA) with diameter stenosis (%DS) and area stenosis (%AS) assessment in all. During TTDE, resting PDV was measured in the LM.
interpretable Doppler signal could be obtained in 24 patients (88% feasibility); therefore these patients entered the final analysis. MLA was 7.1 ± 2.7 mm2. TTDE measured PDV correlated significantly with IVUS-derived MLA (r = -0.46, p < 0.05) and plaque burden (r = 0.51, p < 0.05). Using a velocity cut-off of 112 cm/sec TTDE showed a 92% sensitivity and 62% specificity to identify IVUS-significant (MLA < 6 mm2) LM stenosis.
In angiographically borderline LM disease, resting PDV from transthoracic echocardiography is increased in presence of increased plaque burden by IVUS. TTDE evaluation might be a useful adjunct to other invasive and non-invasive methods in the assessment of borderline LM lesions. Further, large scale studies are needed to establish the exact cut-off value of PDV for routine clinical application.
对于左主干（LM）临界病变（视觉评估狭窄严重程度为30%至50%）的患者，临床决策可能会很困难。本研究的目的是评估经胸多普勒（TTDE）舒张期峰值流速（PDV）与血管内超声（IVUS）测量值之间的关系，以评估血管造影显示的临界LM病变。
本研究纳入了27例因IVUS检查而转诊的临界LM狭窄患者（平均年龄64±8岁，男性21例）。我们对所有患者进行了标准IVUS检查，测量最小管腔面积（MLA）和斑块负荷（PB），并进行了常规定量冠状动脉造影（QCA），评估直径狭窄（%DS）和面积狭窄（%AS）。在TTDE检查期间，测量LM的静息PDV。
24例患者（可行性为88%）可获得可解释的多普勒信号；因此这些患者进入最终分析。MLA为7.1±2.7mm²。TTDE测量的PDV与IVUS得出的MLA（r = -0.46，p < 0.05）和斑块负荷（r = 0.51，p < 0.05）显著相关。使用112 cm/sec的流速截断值时，TTDE对识别IVUS显示的显著（MLA < 6 mm²）LM狭窄的敏感性为92%，特异性为62%。
在血管造影显示的临界LM疾病中，经胸超声心动图测量的静息PDV在IVUS显示斑块负荷增加时会升高。在评估临界LM病变时，TTDE评估可能是其他有创和无创方法的有用辅助手段。此外，需要大规模研究来确定PDV在常规临床应用中的准确截断值。
