Jureidini S B, Marino C J, Waterman B, Syamasundar Rao P, Balfour I C, Chen S C, Nouri S
Department of Pediatrics, Saint Louis University School of Medicine, Cardinal Glennon Children's Hospital, Missouri 63104, USA.
J Am Soc Echocardiogr. 1998 May;11(5):409-20. doi: 10.1016/s0894-7317(98)70019-7.
Transthoracic Doppler color flow and spectral velocity patterns of normal coronary arteries in children have not been well studied. We designed this study to evaluate coronary artery flow velocity characteristics in normal and hypertrophied hearts. Sixty-eight children with optimal two-dimensional echocardiographic images of the left coronary artery (LCA) and right coronary artery (RCA) were prospectively studied. The heart was normal in 45 children, and 23 had left and/or right ventricular hypertrophy assessed by echocardiography (mean age 5.8 versus 5.2 years, p = NS). Color flow signals were detected in the LCA in 63(92%) of the 68 children studied, and pulsed Doppler spectral waveforms were recorded in 47 (69%). The latter were recorded in 26 (58%) of 45 normal children and in 21 (91%) of 23 children with left ventricular hypertrophy. Diastolic RCA flow signals were detected mostly in those with right ventricular hypertrophy (10 of 10). Higher levels of LCA maximum diastolic velocity (42 +/- 23 versus 24 +/- 6 cm/sec, p = 0.0004), increased diastolic flow (16 +/- 15 versus 6 +/- 4 ml/min, p = 0.01), and delayed time to peak diastolic velocity expressed as a percentage of diastolic spectral duration (38% +/- 14% versus 20% +/- 8%, p = 0.0001) were observed in children with left ventricular hypertrophy than in those in normal children. A strong correlation was present between Doppler-derived LCA flow and left ventricular mass/m2 (r = 0.7, p = 0.001). In normal hearts, LCA spectral velocity pattern did not change with increasing age, but the time velocity integral became progressively larger, resulting in a strong correlation with weight (p < 0.001, r = 0.78). This study demonstrates (1) LCA flow signals can be detected and quantitated in the majority of children with and those without left ventricular hypertrophy. (2) Left ventricular hypertrophy is associated with increased LCA flow, higher diastolic velocity, and delayed peak diastolic velocity. (3) RCA flow signals are mostly detected when there is right ventricular hypertrophy. Studies on larger groups of patients are needed to further confirm our observations and to enhance understanding of coronary artery flow reserve.
儿童正常冠状动脉的经胸多普勒彩色血流和频谱速度模式尚未得到充分研究。我们设计了这项研究，以评估正常和肥厚心脏中的冠状动脉血流速度特征。对68例具有最佳二维超声心动图左冠状动脉（LCA）和右冠状动脉（RCA）图像的儿童进行了前瞻性研究。45例儿童心脏正常，23例经超声心动图评估有左和/或右心室肥厚（平均年龄5.8岁对5.2岁，p =无显著性差异）。在68例研究儿童中的63例（92%）检测到LCA中的彩色血流信号，47例（69%）记录到脉冲多普勒频谱波形。后者在45例正常儿童中的26例（58%）以及23例左心室肥厚儿童中的21例（91%）记录到。舒张期RCA血流信号大多在右心室肥厚儿童中检测到（10例中的10例）。与正常儿童相比，左心室肥厚儿童观察到更高水平的LCA最大舒张期速度（42±23对24±6 cm/秒，p = 0.0004）、舒张期血流增加（16±15对6±4 ml/分钟，p = 0.01）以及以舒张期频谱持续时间百分比表示的舒张期峰值速度延迟（38%±14%对20%±8%，p = 0.0001）。多普勒衍生的LCA血流与左心室质量/平方米之间存在强相关性（r = 0.7，p = 0.001）。在正常心脏中，LCA频谱速度模式不随年龄增加而改变，但时间速度积分逐渐增大，与体重存在强相关性（p < 0.001，r = 0.78）。本研究表明：（1）在大多数有和没有左心室肥厚的儿童中都能检测和定量LCA血流信号。（2）左心室肥厚与LCA血流增加、更高的舒张期速度和延迟的舒张期峰值速度相关。（3）当存在右心室肥厚时大多能检测到RCA血流信号。需要对更大组的患者进行研究，以进一步证实我们的观察结果并增进对冠状动脉血流储备的理解。
