Vegsundvåg Johnny, Holte Espen, Wiseth Rune, Hegbom Knut, Hole Torstein
Department of Internal Medicine, Ålesund Hospital, Ålesund, Norway.
Cardiovasc Ultrasound. 2014 Mar 15;12:12. doi: 10.1186/1476-7120-12-12.
Our aim was to assess whether anterograde flow velocities in septal perforating branches could identify an occluded contralateral coronary artery, and to assess the feasibility and accuracy of diagnosing occlusions in the three main coronary arteries by the combined use of several noninvasive parameters indicating collateral flow.
A total of 108 patients scheduled for coronary angiography because of chest pain or acute coronary syndromes were studied using transthoracic Doppler echocardiography.
Anterograde peak diastolic flow velocities (pDV) in septal perforating branches were higher in patients with angiographic occluded contralateral artery compared with corresponding velocities in patients without significant disease in the contralateral artery (0.80 ± 0.31 m/sec versus 0.37 ± 0.13 m/sec, p < 0.001). Receiver operating characteristic curve showed pDV ≥ 0.57 m/sec to be the optimal cutoff value to identify occluded contralateral artery, with a sensitivity of 79% and a specificity of 69%. Demonstration of at least one positive parameter (retrograde flow in main coronary arteries, reversed flow in septal perforating and left circumflex marginal branches, pDV ≥ 0.57 m/sec, or demonstration of other epicardial or intramyocardial collaterals) indicating collateral flow to an occluded main coronary artery had sensitivity, specificity, positive and negative predictive value of 89%, 94%, 63%, and 99%, respectively, for detection of a coronary occlusion. With this combined use of several parameters, 25 of 28 coronary occlusions were identified.
By investigating several parameters indicating collateral flow, we were able to identify most of the main coronary occlusions in the patient cohort. Furthermore, our study demonstrated that coronary artery occlusions may result in complex and diverging coronary pathophysiology depending on which coronary artery segment is occluded and the extent of accompanying coronary artery disease.
ClinicalTrials.gov number NTC00281346.
我们的目的是评估间隔穿支的顺行血流速度是否能够识别对侧冠状动脉闭塞，并通过联合使用多个指示侧支血流的非侵入性参数来评估诊断三大冠状动脉闭塞的可行性和准确性。
对108例因胸痛或急性冠状动脉综合征而计划进行冠状动脉造影的患者采用经胸多普勒超声心动图进行研究。
与对侧动脉无明显病变的患者相比，造影显示对侧动脉闭塞的患者间隔穿支的舒张期峰值顺行血流速度（pDV）更高（0.80±0.31米/秒对0.37±0.13米/秒，p<0.001）。受试者工作特征曲线显示pDV≥0.57米/秒是识别对侧动脉闭塞的最佳临界值，敏感性为79%，特异性为69%。至少有一个指示向闭塞主冠状动脉侧支血流的阳性参数（主冠状动脉逆行血流、间隔穿支和左旋支边缘支反向血流、pDV≥0.57米/秒或其他心外膜或心肌内侧支的显示）对检测冠状动脉闭塞的敏感性、特异性、阳性和阴性预测值分别为89%、94%、63%和99%。通过联合使用这些参数，28例冠状动脉闭塞中有25例被识别。
通过研究多个指示侧支血流的参数，我们能够识别患者队列中的大多数主冠状动脉闭塞。此外，我们的研究表明，冠状动脉闭塞可能导致复杂且不同的冠状动脉病理生理学，这取决于闭塞的冠状动脉节段以及伴随的冠状动脉疾病的程度。
ClinicalTrials.gov编号NTC00281346。
