White C W, Wright C B, Doty D B, Hiratza L F, Eastham C L, Harrison D G, Marcus M L
N Engl J Med. 1984 Mar 29;310(13):819-24. doi: 10.1056/NEJM198403293101304.
To assess visual interpretation of the coronary arteriogram as a means of predicting the physiologic effects of coronary obstructions in human beings, we compared caliper measurements of the degree of coronary stenosis with the reactive hyperemic response of coronary flow velocity studied with a Doppler technique at operation, after 20 seconds of coronary arterial occlusion. In 39 patients (44 vessels) with isolated, discrete coronary lesions varying in severity from 10 to 95 per cent stenosis, measurement of the percentage of stenosis from coronary angiograms was not significantly correlated (r = -0.25) with the reactive hyperemic response. Results were the same for obstructions in the left anterior descending, diagonal, and right coronary arteries. Underestimation of lesion severity occurred in 95 per cent of vessels with greater than 60 per cent stenosis of the diameter by arteriography. Both overestimation and underestimation of lesions with less than 60 per cent stenosis were common. These results, together with the high interobserver and intraobserver variability of standard visual analysis of angiograms, suggest that the physiologic effects of the majority of coronary obstructions cannot be determined accurately by conventional angiographic approaches. The need for improved analytical methods for the physiologic assessment of angiographically detected coronary obstructions is apparent.
为了评估冠状动脉造影的视觉解读作为预测人类冠状动脉阻塞生理效应的一种方法，我们将冠状动脉狭窄程度的卡尺测量值与在手术中采用多普勒技术研究的冠状动脉血流速度的反应性充血反应进行了比较，冠状动脉阻塞20秒后进行测量。在39例患者（44支血管）中，孤立的、离散的冠状动脉病变严重程度从10%到95%不等，冠状动脉造影测量的狭窄百分比与反应性充血反应无显著相关性（r = -0.25）。左前降支、对角支和右冠状动脉阻塞的结果相同。血管造影显示，直径狭窄大于60%的血管中，95%的病变严重程度被低估。狭窄小于60%的病变高估和低估都很常见。这些结果，加上血管造影标准视觉分析中观察者间和观察者内的高变异性，表明大多数冠状动脉阻塞的生理效应不能通过传统的血管造影方法准确确定。显然需要改进用于血管造影检测到的冠状动脉阻塞生理评估的分析方法。
