Iliceto S, Caiati C, Aragona P, Verde R, Schlief R, Rizzon P
Institute of Cardiovascular Diseases, University of Bari, Italy.
J Am Coll Cardiol. 1994 Jan;23(1):184-90. doi: 10.1016/0735-1097(94)90518-5.
We tested the hypothesis that SHU 508A, a new lung-crossing contrast agent capable of increasing the Doppler signal to noise ratio in the right heart as well as left heart cavities after intravenous injection, could increase Doppler signal intensity in coronary arteries, thus improving the feasibility and quality of transesophageal Doppler echocardiographic evaluation of coronary blood flow velocity.
Coronary blood flow velocity can be evaluated by transesophageal Doppler echocardiography. However, an adequate Doppler tracing is obtainable in a relatively low percent of patients.
Transesophageal Doppler echocardiography of coronary arteries was performed in 35 patients before and after SHU 508A injection at four different dosages (200 mg/ml in 5 ml, 200 mg/ml in 10 ml, 300 mg/ml in 5 ml and 300 mg/ml in 10 ml). Color Doppler mapping of coronary flow and pulsed wave Doppler measurement of coronary blood flow velocity were attempted in all patients.
Color Doppler flow mapping of 105 evaluated coronary segments (left main, left anterior descending and circumflex in 35 patients) was not detectable or was weak in 88% of patients before and 33% of patients after echo contrast injection (p < 0.0001); it was optimal (that is, well delineated with complete flow mapping of the explored vessel) in only 11% of patients before and 67% after echo contrast injection (p < 0.0001). In addition, pulsed wave Doppler signal quality improved after echo contrast injection: Pulsed wave Doppler recording of coronary blood flow velocity was not obtainable or was weak in 78% of cases before and 34% after echo contrast injection (p < 0.0001); pulsed wave Doppler recording of coronary blood flow velocity was optimal (that is, there was a complete and well defined outline of diastolic coronary blood flow velocity in 23% of cases before and 66% after echo contrast injection [p < 0.0001]. Both length and width of color Doppler mapping in the left anterior descending coronary artery increased after SHU 508A injection (from 5.75 +/- 5.32 and 1.51 +/- 1.17 to 17.04 +/- 8.76 and 4.21 +/- 1.78 mm, respectively, mean +/- SD, p < 0.0001).
The feasibility and quality of recording coronary blood flow velocity by transesophageal Doppler echocardiography are considerably improved by intravenous injection of SHU 508A. The improved feasibility of this new semi-invasive method for evaluating coronary blood flow velocity and flow reserve can considerably increase its research and clinical utilization.
我们检验了这样一个假设，即SHU 508A是一种新型的可通过肺循环的造影剂，静脉注射后能够提高右心及左心腔的多普勒信号噪声比，它还能增加冠状动脉内的多普勒信号强度，从而提高经食管多普勒超声心动图评估冠状动脉血流速度的可行性和质量。
冠状动脉血流速度可通过经食管多普勒超声心动图进行评估。然而，能获得足够多普勒描记图的患者比例相对较低。
对35例患者在注射四种不同剂量（5ml含200mg/ml、10ml含200mg/ml、5ml含300mg/ml、10ml含300mg/ml）的SHU 508A前后进行冠状动脉的经食管多普勒超声心动图检查。对所有患者尝试进行冠状动脉血流的彩色多普勒成像及冠状动脉血流速度的脉冲波多普勒测量。
在105个评估的冠状动脉节段（35例患者的左主干、左前降支和回旋支）中，在注射超声造影剂前，88%的患者彩色多普勒血流成像不可检测或较弱，注射后这一比例为33%（p<0.0001）；在注射超声造影剂前，仅11%的患者成像最佳（即所探测血管的血流成像清晰完整），注射后这一比例为67%（p<0.0001）。此外，注射超声造影剂后脉冲波多普勒信号质量有所改善：在注射超声造影剂前，78%的病例无法获得或只能获得较弱的冠状动脉血流速度脉冲波多普勒记录，注射后这一比例为34%（p<0.0001）；在注射超声造影剂前，23%的病例冠状动脉血流速度脉冲波多普勒记录最佳（即舒张期冠状动脉血流速度轮廓完整清晰），注射后这一比例为66%（p<0.0001）。注射SHU 508A后，左前降支冠状动脉彩色多普勒成像的长度和宽度均增加（分别从5.75±5.32和1.51±1.17增加至17.04±8.76和4.21±1.78mm，均值±标准差，p<0.0001）。
静脉注射SHU 508A可显著提高经食管多普勒超声心动图记录冠状动脉血流速度的可行性和质量。这种评估冠状动脉血流速度和血流储备的新型半侵入性方法可行性的提高，可显著增加其在研究和临床中的应用。
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