Redberg R F, Sobol Y, Chou T M, Malloy M, Kumar S, Botvinick E, Kane J
Cardiovascular Research Institute, Department of Medicine, University of California, San Francisco 94143-0214, USA.
Circulation. 1995 Jul 15;92(2):190-6. doi: 10.1161/01.cir.92.2.190.
Less invasive methods are replacing traditional invasive means of measuring coronary flow reserve (CFR). Transesophageal echocardiography (TEE) is becoming a useful tool for evaluation of coronary artery disease and has recently been used to measure CFR. This has always been done using dipyridamole, but adenosine has a greater vasodilator potency and more favorable kinetics than dipyridamole. This study was done to evaluate the hypothesis that adenosine is safe, rapid, and accurate in measuring coronary blood flow reserve by TEE Doppler.
Forty-nine patients who had recently undergone angiography had a transesophageal echocardiogram with visualization of the coronary arteries and measurement of blood flow velocity in the left anterior descending coronary artery (LAD) during adenosine infusion of 0.14 mg/kg per minute. Angiograms were analyzed by quantitative coronary angiography, and significant stenosis was defined as > 70% lumenal diameter narrowing. Thirty-nine of the 49 patients did not have a significant LAD stenosis (group 1); the remainder had significant disease (group 2). Good spectral Doppler recordings of blood flow velocity in the LAD were obtained in 41 of 46 patients (89%). There were no significant differences in baseline coronary blood flow velocities between the two groups. Hyperemic to baseline flow ratios were significantly higher in patients without significant LAD stenosis for peak (2.83 +/- 1.04 versus 1.78 +/- 0.36) and mean (2.68 +/- 0.96 versus 1.75 +/- 0.39) diastolic velocity. A CFR ratio > 2.1 had a sensitivity of 86%, a specificity of 79%, a positive predictive value of 46%, and a negative predictive value of 96% for the absence of critical LAD stenosis. The infusion was well tolerated. It had to be prematurely terminated in only 3 patients (6.5%), and they were asymptomatic. No patient experienced chest pain, palpitations, or flushing. Intraobserver and interobserver variabilities were low, and reproducibility of data was good (< 4%).
Adenosine Doppler TEE is an effective, rapid, safe, and superior means of measuring CFR ratio. This method is convenient for serial measurements of CFR as well as in clinical settings such as evaluation of syndrome X, cardiomyopathy, and aortic regurgitation.
侵入性较小的方法正在取代传统的侵入性测量冠状动脉血流储备（CFR）的手段。经食管超声心动图（TEE）正成为评估冠状动脉疾病的一种有用工具，并且最近已被用于测量CFR。以往一直使用双嘧达莫来进行此项测量，但腺苷比双嘧达莫具有更强的血管扩张效力和更有利的动力学特性。本研究旨在评估以下假设：腺苷在通过TEE多普勒测量冠状动脉血流储备方面是安全、快速且准确的。
49例近期接受过血管造影的患者接受了经食管超声心动图检查，在以每分钟0.14mg/kg的速度输注腺苷期间，观察冠状动脉并测量左前降支冠状动脉（LAD）中的血流速度。通过定量冠状动脉造影分析血管造影图像，将显著狭窄定义为管腔直径狭窄>70%。49例患者中有39例LAD无显著狭窄（第1组）；其余患者患有显著病变（第2组）。46例患者中有41例（89%）获得了LAD中血流速度的良好频谱多普勒记录。两组之间的基线冠状动脉血流速度无显著差异。对于舒张末期峰值速度（2.83±1.04对1.78±0.36）和平均速度（2.68±0.96对1.75±0.39），无显著LAD狭窄患者的充血期与基线血流比值显著更高。对于不存在严重LAD狭窄的情况，CFR比值>2.1时，敏感性为86%，特异性为79%，阳性预测值为46%，阴性预测值为96%。输注耐受性良好。仅3例患者（6.5%）不得不提前终止输注，且他们没有症状。没有患者出现胸痛、心悸或脸红。观察者内和观察者间的变异性较低，数据的可重复性良好（<4%）。
腺苷多普勒TEE是测量CFR比值的一种有效、快速、安全且优越的方法。该方法便于对CFR进行系列测量，也适用于诸如X综合征、心肌病和主动脉瓣反流评估等临床情况。
