Li Wei-hong, Li Cui-ping, Li Zhao-ping, Zhang Mo, Li Lei, Ma Xiao-wei, Feng Xin-heng, Gao Wei
Department of Cardiology, Peking University Third Hospital, Beijing, China.
Zhonghua Yi Xue Za Zhi. 2013 Feb 5;93(6):432-5.
To assess the diagnostic accuracy of coronary flow reserve measured by transthoracic Doppler echocardiography (TTDE) associated with adenosine triphosphate (ATP) stress for detecting coronary stenosis in patients with chest pain.
A total of 125 patients scheduled for elective coronary angiography (CAG) due to chest pain were recruited. ATP stress echocardiography were performed to measure CFR in left anterior descending (LAD) by TTDE with 2 days pre-CAG. Coronary flow reserve (CFR) was calculated as peak diastolic velocity during maximum hyperemia (PDV2) divided by baseline (PDV1). According to the coronary angiography results, all patients were divided into group A (stenosis < 50% in LAD, n = 57), group B (stenosis of 50% - 75% in LAD, n = 20) and group C (stenosis > 75% in LAD, n = 48). Then CFR was compared among three groups. The receiver operating characteristic curve (ROC) was used to assess the value of CFR for detecting LAD stenosis.
CFR was significantly different among three groups (group A: 3.02 ± 0.85, group B: 2.49 ± 0.65, group C: 1.82 ± 0.56; all P < 0.01). With ROC analysis, CFR < 2.2 was the best cut-off value for diagnosing significant LAD stenosis (area under curve: 0.86 (95% CI 0.80 to 0.93)), with sensitivity of 81%, specificity of 83% and accuracy of 82%; CFR < 2.2 for diagnosing LAD stenosis > 50% (area under curve: 0.81 (95%CI 0.74 - 0.89, P < 0.01)), with a sensitivity of 59%, a specificity of 82% and an accuracy of 70%.
CFR measured by TTDE associated with ATP stress is a valuable tool for screening significant stenosis in patients with chest pain. Its advantages are non-invasiveness, easy availability, safety and inexpensiveness.
评估经胸多普勒超声心动图（TTDE）联合三磷酸腺苷（ATP）负荷试验测量的冠状动脉血流储备（CFR）对胸痛患者冠状动脉狭窄的诊断准确性。
共纳入125例因胸痛计划行择期冠状动脉造影（CAG）的患者。在CAG前2天，采用TTDE行ATP负荷超声心动图测量左前降支（LAD）的CFR。冠状动脉血流储备（CFR）计算为最大充血期舒张末期峰值流速（PDV2）除以基线舒张末期峰值流速（PDV1）。根据冠状动脉造影结果，将所有患者分为A组（LAD狭窄<50%，n = 57）、B组（LAD狭窄50% - 75%，n = 20）和C组（LAD狭窄>75%，n = 48）。然后比较三组的CFR。采用受试者工作特征曲线（ROC）评估CFR对检测LAD狭窄的价值。
三组间CFR差异有统计学意义（A组：3.02±0.85，B组：2.49±0.65，C组：1.82±0.56；均P<0.01）。通过ROC分析，CFR<2.2是诊断LAD明显狭窄的最佳截断值（曲线下面积：0.86（95%CI 0.80至0.93）），敏感性为81%，特异性为83%，准确性为82%；CFR<2.2用于诊断LAD狭窄>50%（曲线下面积：0.81（95%CI 0.74 - 0.89，P<0.01）），敏感性为59%，特异性为82%，准确性为70%。
TTDE联合ATP负荷试验测量的CFR是筛查胸痛患者明显狭窄的有价值工具。其优点是无创、易于获得、安全且费用低廉。
