Department of Cardiology, Amsterdam UMC, Vrije Universiteit, ZH 5F003, De Boelelaan 1117, Amsterdam, the Netherlands.
Department of Cardiology, Catharina hospital, Eindhoven, the Netherlands.
Eur Heart J. 2019 Jul 21;40(28):2350-2359. doi: 10.1093/eurheartj/ehz245.
Continuous thermodilution is a novel technique to quantify absolute coronary flow and microvascular resistance (MVR). Notably, intracoronary infusion of saline elicits maximal hyperaemia, obviating the need for adenosine. The primary aim of this study was to validate continuous thermodilution in humans by comparing invasive measurements to [15O]H2O positron emission tomography (PET). As a secondary goal, absolute flow and MVR were compared between invasive measurements obtained with and without adenosine.
Twenty-five patients underwent coronary computed tomography angiography (CCTA), [15O]H2O PET, and invasive assessment. Absolute coronary flow and MVR were measured in the left anterior descending and left circumflex artery using a dedicated infusion catheter and a temperature/pressure sensor-tipped guidewire. Invasive measurements were performed with and without adenosine. In order to compare invasive flow measurements with PET perfusion, subtending myocardial mass of the investigated vessels was derived from CCTA using the Voronoi algorithm. Invasive and non-invasive measurements of adenosine-induced hyperaemic flow and MVR showed strong correlation (r = 0.91; P < 0.001 for flow and r = 0.85; P < 0.001 for MVR) and good agreement [intraclass correlation coefficient (ICC) = 0.90; P < 0.001 for flow and ICC = 0.79; P < 0.001 for MVR]. Absolute flow and MVR also correlated well between measurements with and without adenosine (r = 0.97; P < 0.001 for flow and r = 0.98; P < 0.001 for MVR) and showed good agreement (ICC = 0.96; P < 0.001 for flow and ICC = 0.98; P < 0.001 for MVR).
Continuous thermodilution is an accurate method to measure absolute coronary flow and MVR, which is evidenced by strong agreement with [15O]H2O PET derived flow and resistance. Absolute flow and MVR correlate highly between invasive measurements obtained with and without adenosine, which confirms that intracoronary infusion of room temperature saline elicits steady-state maximal hyperaemia.
连续温度稀释法是一种用于量化绝对冠状动脉流量和微血管阻力（MVR）的新技术。值得注意的是，冠状动脉内输注盐水可引发最大充血，从而无需使用腺苷。本研究的主要目的是通过将连续温度稀释法与[15O]H2O 正电子发射断层扫描（PET）进行比较，对其在人体中的应用进行验证。作为次要目标，比较了在有无腺苷的情况下通过侵入性测量获得的绝对流量和 MVR。
25 例患者接受了冠状动脉计算机断层血管造影（CCTA）、[15O]H2O PET 和侵入性评估。使用专用输注导管和带温度/压力传感器的导丝，在左前降支和左旋支中测量绝对冠状动脉流量和 MVR。在有无腺苷的情况下进行了侵入性测量。为了将侵入性流量测量与 PET 灌注进行比较，使用 Voronoi 算法从 CCTA 推导了研究血管的心肌质量。腺苷诱导的充血性流量和 MVR 的侵入性和非侵入性测量结果具有很强的相关性（r=0.91；P<0.001，用于流量；r=0.85；P<0.001，用于 MVR），且一致性良好（组内相关系数（ICC）=0.90；P<0.001，用于流量；ICC=0.79；P<0.001，用于 MVR）。有和无腺苷的测量值之间的绝对流量和 MVR 也具有良好的相关性（r=0.97；P<0.001，用于流量；r=0.98；P<0.001，用于 MVR），且一致性良好（ICC=0.96；P<0.001，用于流量；ICC=0.98；P<0.001，用于 MVR）。
连续温度稀释法是一种准确测量绝对冠状动脉流量和 MVR 的方法，这一点可通过与[15O]H2O PET 衍生的流量和阻力的强烈一致性得到证实。有和无腺苷的侵入性测量值之间的绝对流量和 MVR 具有高度相关性，这证实了室温盐水的冠状动脉内输注可引发稳定状态下的最大充血。
