Mundigler G, Zehetgruber M, Christ G, Siostrzonek P
Department of Cardiology, University of Vienna, Austria.
Clin Cardiol. 1997 Mar;20(3):225-31. doi: 10.1002/clc.4960200308.
Currently used methods for assessment of coronary flow reserve are invasive and require extensive laboratory equipment. Recently, noninvasive assessment of coronary flow reserve by transesophageal Doppler evaluation of coronary sinus (CS) or left anterior descending coronary artery (LAD) flow has been proposed. Direct comparison between these two techniques is lacking.
Doppler recordings of CS and LAD flow velocity were obtained before and after 0.6 mg/kg/5 min dipyridamole in 16 patients with significant stenosis of the LAD (Group A) and in 14 control patients (Group B). Flow recordings and all measurements were performed in a blinded manner. For assessment of coronary flow reserve, Doppler measurements after dipyridamole were divided by the respective baseline values.
Doppler studies of the CS and LAD were feasible in 30 of 30 (100%) and 23 of 30 (71%) patients, respectively. Analyzing the maximum flow velocities, coronary flow reserve in Groups A and B was 1.18 +/- 0.28 and 1.68 +/- 0.53 with CS recordings and 1.78 +/- 0.83 and 2.51 +/- 0.76 with LAD recordings, respectively. Analyzing the velocity time integrals, coronary flow reserve in Groups A and B was 1.53 +/- 0.68 and 2.59 +/- 0.74 with CS recordings and 1.77 +/- 0.38 and 2.68 +/- 0.93 with LAD recordings, respectively. Correlation between LAD and CS recordings was 0.69 (p < 0.001), when coronary flow reserve was calculated from the velocity time integral and 0.68 (p < 0.001) when the maximum flow velocities were used.
Both transesophageal Doppler techniques might be useful for noninvasive assessment of coronary flow reserve.
目前用于评估冠状动脉血流储备的方法具有侵入性，且需要大量实验室设备。最近，有人提出通过经食管多普勒评估冠状窦（CS）或左前降支冠状动脉（LAD）血流来对冠状动脉血流储备进行无创评估。这两种技术之间缺乏直接比较。
在16例LAD严重狭窄患者（A组）和14例对照患者（B组）中，于静脉注射0.6mg/kg/5min双嘧达莫前后获取CS和LAD血流速度的多普勒记录。血流记录和所有测量均采用盲法进行。为评估冠状动脉血流储备，将双嘧达莫后的多普勒测量值除以各自的基线值。
CS和LAD的多普勒研究分别在30例患者中的30例（100%）和30例中的23例（71%）可行。分析最大血流速度时，A组和B组通过CS记录的冠状动脉血流储备分别为1.18±0.28和1.68±0.53，通过LAD记录分别为1.78±0.83和2.51±0.76。分析速度时间积分时，A组和B组通过CS记录的冠状动脉血流储备分别为1.53±0.68和2.59±0.74，通过LAD记录分别为1.77±0.38和2.68±0.93。当根据速度时间积分计算冠状动脉血流储备时，LAD和CS记录之间的相关性为0.69（p<0.001），使用最大血流速度时相关性为0.68（p<0.001）。
两种经食管多普勒技术可能都有助于对冠状动脉血流储备进行无创评估。
