Cardiovascular Centre Aalst, OLV Clinic, Aalst, Belgium.
EuroIntervention. 2021 Jul 20;17(4):e309-e316. doi: 10.4244/EIJ-D-20-00684.
Absolute hyperaemic coronary blood flow (Q, in mL/min) and resistance (R, in Wood units [WU]) can be measured invasively by continuous thermodilution.
The aim of this study was to assess normal reference values of Q and R.
In 177 arteries (69 patients: 25 controls, i.e., without identifiable coronary atherosclerosis; 44 patients with mild, non-obstructive atherosclerosis), thermodilution-derived hyperaemic Q and total, epicardial, and microvascular absolute resistances (Rtot, Repi, and Rmicro) were measured. In 20 controls and 29 patients, measurements were obtained in all three major coronary arteries, thus allowing calculations of Q and R for the whole heart. In 15 controls (41 vessels) and 25 patients (71 vessels), vessel-specific myocardial mass was derived from coronary computed tomography angiography.
Whole heart hyperaemic Q tended to be higher in controls compared to patients (668±185 vs 582±138 mL/min, p=0.068). In the left anterior descending coronary artery (LAD), hyperaemic Q was significantly higher (293±102 mL/min versus 228±71 mL/min, p=0.004) in controls than in patients. This was driven mainly by a difference in Repi (43±23 vs 83±41 WU, p=0.048), without significant differences in Rmicro. After adjustment for vessel-specific myocardial mass, hyperaemic Q was similar in the three vascular territories (5.9±1.9, 4.9±1.7, and 5.3±2.1 mL/min/g, p=0.44, in the LAD, left circumflex and right coronary artery, respectively).
The present report provides reference values of absolute coronary hyperaemic Q and R. Q was homogeneously distributed in the three major myocardial territories but the large ranges of observed hyperaemic values of flow and of microvascular resistance preclude their clinical use for inter-patient comparison.
绝对充血性冠状动脉血流（Q，以毫升/分钟计）和阻力（R，以伍德单位[WU]计）可通过连续温差法进行侵入性测量。
本研究旨在评估 Q 和 R 的正常参考值。
在 177 条动脉（69 例患者：25 例对照，即无可识别的冠状动脉粥样硬化；44 例轻度非阻塞性动脉粥样硬化）中，通过温差法测量充血性 Q 和总、心外膜和微血管绝对阻力（Rtot、Repi 和 Rmicro）。在 20 例对照和 29 例患者中，在所有三条主要冠状动脉中进行了测量，从而可以计算整个心脏的 Q 和 R。在 15 例对照（41 条血管）和 25 例患者（71 条血管）中，从冠状动脉计算机断层血管造影术得出血管特异性心肌质量。
整个心脏充血性 Q 倾向于在对照组中高于患者（668±185 与 582±138 毫升/分钟，p=0.068）。在左前降支冠状动脉（LAD）中，对照组的充血性 Q 明显高于患者（293±102 与 228±71 毫升/分钟，p=0.004）。这主要是由于 Repi 差异所致（43±23 与 83±41 WU，p=0.048），而微血管阻力无显著差异。在校正血管特异性心肌质量后，三个血管区域的充血性 Q 相似（LAD、左回旋支和右冠状动脉分别为 5.9±1.9、4.9±1.7 和 5.3±2.1 毫升/分钟/克，p=0.44）。
本报告提供了绝对充血性冠状动脉 Q 和 R 的参考值。Q 在三个主要心肌区域均匀分布，但观察到的流量和微血管阻力的充血性值的大范围排除了其用于患者间比较的临床应用。
