Deychak Y A, Segal J, Reiner J S, Rohrbeck S C, Thompson M A, Lundergan C F, Ross A M, Wasserman A G
Department of Medicine, George Washington University Medical Center, Washington, DC 20037.
Am Heart J. 1995 Feb;129(2):219-27. doi: 10.1016/0002-8703(95)90001-2.
A Doppler guide wire was used to measure phasic coronary blood flow velocity distal to coronary stenoses in 17 symptomatic patients with corresponding positive exercise or adenosine thallium scintigrams. Distal average peak velocity and diastolic/systolic flow-velocity ratio were obtained in 16 vessels with stenoses (55% to 85% diameter stenosis) and a corresponding reversible thallium defect and in 11 control vessels with no stenosis or thallium defect. Coronary flow-velocity reserve was obtained with intracoronary adenosine. Coronary flow reserve (2.3 +/- 0.4 vs 1.2 +/- 0.3, p < 0.01) and diastolic/systolic flow-velocity ratio (1.95 +/- 0.56 vs 1.44 +/- 0.59, p < 0.04) were significantly different between normal vessels and distal to stenoses, respectively. Excellent concordance between distal coronary flow reserve and diastolic/systolic flow-velocity ratio to thallium scintigraphy was noted. A coronary flow reserve of < 1.8 and a diastolic/systolic flow-velocity ratio of < 1.7 predicted a reversible thallium perfusion scintigram (concordance 96% and 88%, respectively). Distal coronary flow velocity indexes may provide an alternative means of physiologic assessment of lesion severity during coronary angiography.
使用多普勒导丝测量了17例有症状患者冠状动脉狭窄远端的阶段性冠状动脉血流速度，这些患者运动试验或腺苷铊闪烁扫描结果呈阳性。在16条存在狭窄（直径狭窄55%至85%）且伴有相应可逆性铊缺损的血管以及11条无狭窄或铊缺损的对照血管中，获取了远端平均峰值速度和舒张期/收缩期流速比值。通过冠状动脉内注射腺苷获得冠状动脉血流储备。正常血管与狭窄远端的冠状动脉血流储备（分别为2.3±0.4与1.2±0.3，p<0.01）和舒张期/收缩期流速比值（分别为1.95±0.56与1.44±0.59，p<0.04）存在显著差异。观察到冠状动脉远端血流储备与舒张期/收缩期流速比值与铊闪烁扫描之间具有良好的一致性。冠状动脉血流储备<1.8以及舒张期/收缩期流速比值<1.7可预测可逆性铊灌注闪烁扫描结果（一致性分别为96%和88%）。冠状动脉远端血流速度指标可为冠状动脉造影时病变严重程度的生理评估提供一种替代方法。
