Grill H P, Brinker J A, Taube J C, Walford G D, Midei M G, Flaherty J T, Weiss J L
Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland.
J Am Coll Cardiol. 1990 Dec;16(7):1594-600. doi: 10.1016/0735-1097(90)90306-a.
Conventional coronary arteriography is able to demonstrate the presence of coronary collateral vessels but cannot delineate the specific region of myocardium to which they supply blood. To test the hypothesis that contrast echocardiography can specifically identify collateralized myocardium, contrast echocardiographic perfusion "maps" were compared in patients with (n = 12) and without (n = 12) angiographic evidence of coronary collateral flow, both before and after coronary angioplasty. Contrast echocardiographic images of the mid-left ventricle in the short-axis view at end-diastole were obtained after separate injections of a sonicated contrast agent into both the right and the left coronary arteries. A computer-based contouring system was used to determine the individual areas of myocardium perfused by each of the two coronary arteries and then to superimpose the images of the two perfusion beds. The resulting area of overlapping perfusion represented myocardium receiving blood flow from both coronary systems and was defined as collateralized myocardium. To normalize for heart size, overlap area was expressed as a percent of total myocardial area, which was the area between endocardium and epicardium in the short-axis view. To adjust for differences in vascular distribution, overlap area was expressed as a percent of the perfusion area of the recipient vessel. In patients with angiographic collateral flow, the recipient vessel was that vessel receiving the collateral flow. In patients without angiographic collateral flow, the right coronary artery was considered the recipient vessel. Overlap area was 1.3 +/- 0.4% of total myocardial area and 6.6 +/- 1.7% of recipient vessel area in patients without angiographic evidence of collateral flow compared with 30.6 +/- 2.5% and 89.2 +/- 6.4%, respectively, in patients with angiographic collateral flow (p less than 0.001 for both). In four patients in whom angiographic collateral flow was abolished by angioplasty, overlap area decreased from 30.3 +/- 5.3% to 6.8 +/- 2.7% of total myocardial area and from 100% to 18.5 +/- 5.4% of recipient vessel area (p less than 0.05 for both). Thus, contrast echocardiography is able to map the specific myocardial territory perfused by coronary collateral flow and document an immediate reduction in perfusion in this territory when collateral flow is abolished by angioplasty.
传统冠状动脉造影能够显示冠状动脉侧支血管的存在，但无法描绘出这些侧支血管供血的心肌的特定区域。为了验证对比超声心动图能够特异性识别侧支循环心肌的假说，对有（n = 12）和无（n = 12）冠状动脉侧支血流血管造影证据的患者在冠状动脉成形术前和术后进行了对比超声心动图灌注“图”的比较。在分别向左右冠状动脉注射超声造影剂后，获取舒张末期短轴视图下左心室中部的对比超声心动图图像。使用基于计算机的轮廓系统确定由两条冠状动脉各自灌注的心肌的个体区域，然后叠加两个灌注床的图像。由此产生的重叠灌注区域代表接受来自两个冠状动脉系统血流的心肌，被定义为侧支循环心肌。为了使心脏大小标准化，重叠面积表示为总心肌面积的百分比，总心肌面积是短轴视图下心内膜和心外膜之间的面积。为了调整血管分布的差异，重叠面积表示为接受血管灌注面积的百分比。在有血管造影侧支血流的患者中，接受血管是接受侧支血流的血管。在无血管造影侧支血流的患者中，右冠状动脉被视为接受血管。在无血管造影侧支血流证据的患者中，重叠面积为总心肌面积的1.3±0.4%和接受血管面积的6.6±1.7%，而在有血管造影侧支血流的患者中分别为30.6±2.5%和89.2±6.4%（两者p均小于0.001）。在4例经血管成形术消除血管造影侧支血流的患者中，重叠面积从总心肌面积的30.3±5.3%降至6.8±2.7%，从接受血管面积的100%降至18.5±5.4%（两者p均小于0.05）。因此，对比超声心动图能够描绘出由冠状动脉侧支血流灌注的特定心肌区域，并记录当血管成形术消除侧支血流时该区域灌注的立即减少。
