Bach R G, Kern M J
Division of Cardiology, St. Louis University School of Medicine, Missouri, USA.
Cardiol Clin. 1997 Feb;15(1):77-99. doi: 10.1016/s0733-8651(05)70320-9.
Coronary angiography incompletely delineates the physiologic consequences of many epicardial stenoses. Intracoronary translesional flow velocity measurements using the Doppler flow wire during cardiac catheterization provide immediate data discriminating the physiologic significance of coronary stenoses. The validity and accuracy of the flow wire for analyzing lesion hemodynamic significance have been confirmed in multiple studies. Flow velocity analysis provides objective criteria for refining the selection of cases for revascularization, and prospective clinical data have confirmed the safety of deferring intervention on lesions with normal physiologic assessment. Translesional and distal coronary flow velocity dynamics during procedures also provide immediate data assessing the physiologic adequacy of intervention. Impaired postintervention distal coronary flow velocity and vasodilator reserve can predict subsequent clinical events, and comparisons of flow velocity indices prestenting and poststenting suggest that physiologically inadequate results of angioplasty may be improved by additional intervention. Flow velocity assessment may also have utility in profiling the adequacy of infarct artery reperfusion following acute myocardial infarction. Evidence has been accumulated to support use of Doppler flow velocity analysis as a clinically relevant technique for improving both diagnostic and therapeutic aspects of cardiovascular medicine.
冠状动脉造影不能完全描绘出许多心外膜狭窄的生理后果。在心脏导管插入术期间，使用多普勒血流导丝进行冠状动脉内跨病变血流速度测量可提供即时数据，以区分冠状动脉狭窄的生理意义。多项研究已证实血流导丝分析病变血流动力学意义的有效性和准确性。血流速度分析为优化血运重建病例的选择提供了客观标准，前瞻性临床数据已证实，对于生理评估正常的病变推迟干预是安全的。手术过程中的跨病变和冠状动脉远端血流速度动态变化也提供了评估干预生理充分性的即时数据。干预后冠状动脉远端血流速度和血管扩张储备受损可预测随后的临床事件，支架置入前和支架置入后血流速度指标的比较表明，通过额外干预可能改善血管成形术生理效果不佳的情况。血流速度评估在评估急性心肌梗死后梗死动脉再灌注的充分性方面也可能有用。已有证据支持将多普勒血流速度分析作为一种临床相关技术，用于改善心血管医学的诊断和治疗。
