Kozàkovà M, Palombo C, Zanchi M, Distante A, L'Abbate A
National Research Council, Institute of Clinical Physiology, Pisa, Italy.
J Am Soc Echocardiogr. 1994 Jul-Aug;7(4):327-36. doi: 10.1016/s0894-7317(14)80190-9.
Transesophageal echocardiography (TEE) combined with color and pulsed Doppler allows a noninvasive assessment of flow in the proximal anterior descending coronary artery (LAD). The aim of this study was to assess whether the peripheral administration of a transpulmonary stable echocontrast agent with prolonged in vivo stability may improve the feasibility and accuracy of coronary flow detection by TEE Doppler. In 12 out of 14 consecutive patients undergoing routine diagnostic TEE examination, color-coded images of left main coronary artery (LM) and the origin of the LAD and circumflex artery (CXA), as well as spectral Doppler signals from the LAD, were evaluated before and after intravenous injection of SHU 508 A. After administration of echocontrast material, the coronary Doppler signal (both color-coded and spectral) was enhanced for approximately 100 seconds. The length and diameter of color-coded flow increased significantly in the LM, LAD, and CXA. (The length of color-coded flow before and after injection of contrast material were the following: in LM 0.94 +/- 0.44 versus 1.39 +/- 0.52 cm, p < 0.001; in LAD 0.68 +/- 0.36 versus 1.20 +/- 0.41 cm, p < 0.001; and in CXA 0.54 +/- 0.20 versus 1.06 +/- 0.86 cm; in this artery, color-coded flow was visualized only in six patients before and 11 patients after injection of contrast material. The corresponding values for the diameters of color-coded flow in LM were 0.36 +/- 0.08 versus 0.46 +/- 0.09 cm, p < 0.001; in LAD 0.29 +/- 0.07 versus 0.41 +/- 0.1 cm, p < 0.002; and in CXA 0.26 +/- 0.05 versus 0.40 +/- 0.04 cm.) By pulsed Doppler, significant increments in peak diastolic (47.8 +/- 21.3 versus 37.2 +/- 14.5 cm/sec, p < 0.05), mean diastolic (37.4 +/- 14.7 versus 27.9 +/- 8.4 cm/sec, p < 0.005), mean systolic flow velocity (23.2 +/- 6.8 versus 19.0 +/- 4.7 cm/sec, p < 0.005), and diastolic (11.0 +/- 3.9 versus 7.7 +/- 3.0 cm, p < 0.001) and total flow integral (16.8 +/- 5.3 versus 10.5 +/- 4.6 cm, p < 0.001) were observed. By contrast, peak systolic velocity did not increase. However, the systolic component of coronary flow, detectable in 7 out of 12 patients before injection of contrast material, became detectable in all 12 patients after injection of contrast material.(ABSTRACT TRUNCATED AT 400 WORDS)
经食管超声心动图（TEE）结合彩色和脉冲多普勒技术可对近端前降支冠状动脉（LAD）内的血流进行无创评估。本研究的目的是评估经外周静脉注射一种在体内具有较长稳定性的经肺稳定超声造影剂是否能提高TEE多普勒检测冠状动脉血流的可行性和准确性。在连续接受常规诊断性TEE检查的14例患者中的12例中，在静脉注射SHU 508 A之前和之后，对左冠状动脉主干（LM）、LAD起始部和回旋支动脉（CXA）的彩色编码图像以及来自LAD的频谱多普勒信号进行了评估。注射超声造影剂后，冠状动脉多普勒信号（彩色编码和频谱）增强约100秒。LM、LAD和CXA中彩色编码血流的长度和直径显著增加。（注射造影剂前后彩色编码血流的长度如下：LM中为0.94±0.44对1.39±0.52 cm，p<0.001；LAD中为0.68±0.36对1.20±0.41 cm，p<0.001；CXA中为0.54±0.20对1.06±0.86 cm；在该动脉中，注射造影剂前仅6例患者可见彩色编码血流，注射后为11例。LM中彩色编码血流直径的相应值为0.36±0.08对0.46±0.09 cm，p<0.001；LAD中为0.29±0.07对0.41±0.1 cm，p<0.002；CXA中为0.26±0.05对0.40±0.04 cm。）通过脉冲多普勒，舒张期峰值（47.8±21.3对37.2±14.5 cm/秒，p<0.05）、平均舒张期（37.4±14.7对27.9±8.4 cm/秒，p<0.005）、平均收缩期血流速度（23.2±6.8对19.0±4.7 cm/秒，p<0.005）以及舒张期（11.0±3.9对7.7±3.0 cm，p<0.001）和总血流积分（16.8±5.3对10.5±4.6 cm，p<0.001）均有显著增加。相比之下，收缩期峰值速度未增加。然而，注射造影剂前12例患者中有7例可检测到的冠状动脉血流收缩期成分，注射后在所有12例患者中均可检测到。（摘要截选至400字）
