Department of Cardiology, Yokkaichi Social Insurance Hospital, Yokkaichi, Japan.
Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan.
J Am Soc Echocardiogr. 2014 Jul;27(7):775-85. doi: 10.1016/j.echo.2014.02.012. Epub 2014 Mar 26.
There have been no clinical data specifying the degree of calcium deposition at which coronary flow velocity reserve (CFVR) measurement using transthoracic Doppler echocardiography surpasses 320-row multidetector computed tomographic coronary angiography (CTCA) in detecting obstructive coronary artery disease.
One hundred seventy patients who underwent invasive coronary angiography, transthoracic Doppler echocardiography, and CTCA were prospectively enrolled. Coronary artery stenosis was defined as percentage diameter stenosis ≥ 50% on invasive coronary angiography. CFVR < 2.0 and narrowing ≥ 50% measured with CTCA were the thresholds indicating the presence of coronary artery stenosis. The degree of coronary artery calcification was also assessed using the Agatston calcium score method by computed tomography.
The majority of patients (89%) were classified as having either high or intermediate pretest probability of coronary artery disease. Significant coronary artery stenoses by invasive coronary angiography were found in 71 patients and 104 vessels. Although the overall diagnostic performance of CTCA was comparable with that of CFVR measurement for detecting coronary artery stenosis, only the diagnostic performance of CTCA was negatively affected by the extent of a patient's coronary artery calcification. Receiver operating characteristic curve analysis indicated that only CFVR measurement is diagnostically accurate when calcium scores are >319 in the patient-based assessment, 189 for the left anterior descending coronary artery, 98 for the left circumflex coronary artery and 282 for the right coronary artery.
Transthoracic Doppler echocardiography and 320-row multidetector CTCA successfully diagnosed significant coronary artery stenosis with high feasibility and accuracy. However, only the diagnostic performance of CTCA was negatively affected by the extent of a patient's coronary artery calcification, and therefore the diagnostic performance of CFVR measurement for detecting coronary artery stenosis surpassed that of CTCA when the calcium score exceeded specified cutoff values.
目前尚无临床数据明确指出经胸多普勒超声心动图测量冠状动脉血流储备（CFVR）在检测阻塞性冠状动脉疾病方面超过 320 层多排 CT 冠状动脉造影（CTCA）的钙沉积程度。
前瞻性纳入 170 例接受经皮冠状动脉造影、经胸多普勒超声心动图和 CTCA 的患者。冠状动脉狭窄定义为经皮冠状动脉造影的直径狭窄百分比≥50%。CFVR<2.0 和 CTCA 测量的狭窄≥50%是提示存在冠状动脉狭窄的阈值。冠状动脉钙化程度也通过计算机断层扫描的 Agatston 钙评分法进行评估。
大多数患者（89%）被归类为具有高或中危的冠状动脉疾病预测概率。71 例患者和 104 支血管存在明显的冠状动脉狭窄。尽管 CTCA 的总体诊断性能与 CFVR 测量相当，但仅 CTCA 的诊断性能受到患者冠状动脉钙化程度的影响。受试者工作特征曲线分析表明，只有当患者的钙评分>319 时，CFVR 测量在基于患者的评估中具有诊断准确性，在左前降支为 189，左旋支为 98，右冠状动脉为 282。
经胸多普勒超声心动图和 320 层多排 CT 成功诊断了高可行性和准确性的显著冠状动脉狭窄。然而，只有 CTCA 的诊断性能受到患者冠状动脉钙化程度的影响，因此当钙评分超过特定截止值时，CFVR 测量检测冠状动脉狭窄的诊断性能超过 CTCA。
