Erbel R, Ge J, Bockisch A, Kearney P, Görge G, Haude M, Schümann D, Zamorano J, Rupprecht H J, Meyer J
Department of Cardiology, University of Essen, Germany.
Eur Heart J. 1996 Jun;17(6):880-9. doi: 10.1093/oxfordjournals.eurheartj.a014969.
A substantial proportion of patients undergoing heart catheterization for suspected coronary artery disease have normal angiograms. Coronary morphology and blood flow velocity can be assessed very accurately with intracoronary ultrasound and Doppler. The purpose of this study was to use both methods to classify further patients with suspected coronary artery disease but with coronary angiograms adjudged normal at the time.
In forty-four patients with suspected coronary artery disease and normal coronary angiograms, intracoronary ultrasound and intracoronary Doppler were performed in the left anterior descending and left main coronary arteries. Coronary flow reserve was obtained by calculating the ratio of the maximal coronary flow mean velocity after the intracoronary administration of 10 mg papaverine to the coronary flow mean velocity at rest. Of 44 patients, 16 (36%) (group I) were found to have normal coronary morphology by intracoronary ultrasound and normal (> 3.0) coronary flow reserve (5.3 +/- 1.8). In seven patients (16%) (group II) there were normal intracoronary ultrasonic findings but a reduced coronary flow reserve (2.1 +/- 0.4). Plaque formation was found in a total of 21 (48%) of the 44 patients; mean plaque sizes were 3.6 +/- 1.6 mm2 for those in group III (normal coronary flow reserve) and 5.0 +/- 2.3 mm2 for those in group IV (reduced coronary flow reserve). Vessel area in both of these groups (16.3 +/- 8.0 mm2 and 19.2 +/- 6.1 mm2) was significantly larger than that of group I (14.6 +/- 5.7 mm2, P < 0.01). Plaque calcification was found in 25% of those in group III and 44% of those in group IV. Thus, only 36% of the patients with normal angiograms were true normal, 48% exhibited early stage of coronary atherosclerosis, and the other 16% might be considered as syndrome X.
Intracoronary ultrasound and Doppler can be used to differentiate further heart disease in patients with normal coronary angiograms. Only a minority were true normal. Early signs of atherosclerosis cannot be detected by coronary angiography. This may have important therapeutic and prognostic implications.
因疑似冠状动脉疾病接受心脏导管插入术的患者中，相当一部分人的血管造影显示正常。冠状动脉形态和血流速度可通过冠状动脉内超声和多普勒技术进行非常准确的评估。本研究的目的是使用这两种方法对疑似冠状动脉疾病但当时冠状动脉血管造影判定为正常的患者进行进一步分类。
对44例疑似冠状动脉疾病且冠状动脉血管造影正常的患者，在左前降支和左主干冠状动脉进行冠状动脉内超声和冠状动脉内多普勒检查。冠状动脉血流储备通过计算冠状动脉内注射10毫克罂粟碱后最大冠状动脉血流平均速度与静息时冠状动脉血流平均速度之比获得。44例患者中，16例（36%）（第一组）经冠状动脉内超声检查显示冠状动脉形态正常且冠状动脉血流储备正常（>3.0）（5.3±1.8）。7例患者（占16%，第二组）冠状动脉内超声检查结果正常，但冠状动脉血流储备降低（2.1±0.4）。44例患者中共有21例（48%）发现有斑块形成；第三组（冠状动脉血流储备正常）患者的平均斑块大小为3.6±1.6平方毫米，第四组（冠状动脉血流储备降低）患者的平均斑块大小为5.0±2.3平方毫米。这两组的血管面积（分别为16.3±8.0平方毫米和19.2±6.1平方毫米）均显著大于第一组（14.6±5.7平方毫米，P<0.01）。第三组25%的患者和第四组44%的患者发现有斑块钙化。因此，血管造影正常的患者中只有36%是真正正常的，48%表现为冠状动脉粥样硬化早期，另外16%可能被视为X综合征。
冠状动脉内超声和多普勒可用于对冠状动脉血管造影正常的患者进一步鉴别心脏病。只有少数人是真正正常的。冠状动脉造影无法检测到动脉粥样硬化的早期迹象。这可能具有重要的治疗和预后意义。
