Seiler C, Fleisch M, Garachemani A, Meier B
Department of Cardiology, University Hospital, Bern, Switzerland.
J Am Coll Cardiol. 1998 Nov;32(5):1272-9. doi: 10.1016/s0735-1097(98)00384-2.
This study evaluated two methods for the quantitative measurement of collaterals using intracoronary (IC) blood flow velocity or pressure measurements.
The extent of myocardial necrosis after coronary artery occlusion is substantially influenced by the collateral circulation. So far, qualitative methods have been available to assess the human coronary collateral circulation, thus restraining the conclusive investigation of, for example, therapies to promote collateral development.
Fifty-one patients with a coronary artery stenosis to be treated by percutaneous transluminal coronary angioplasty (PTCA) were investigated using IC PTCA guidewire-based Doppler and pressure sensors positioned distal to the stenosis. Simultaneous measurements of aortic pressure, IC velocity and pressure distal to the stenosis during and after PTCA provided the variables for calculating collateral flow indices (CFIv and CFIp) that express collateral flow as a fraction of flow via the patent vessel. Both CFIv and CFIp were compared with conventional methods for collateral assessment, among them ST-segment changes >1 mm on IC and surface electrocardiogram (ECG) at PTCA. Also, CFIv and CFIp were compared with each other.
In 11 patients without ECG signs of ischemia during PTCA (sufficient collaterals), relative collateral flow amounted to 46% as determined by Doppler and pressure wire. Patients with insufficient collaterals (n=40) had relative collateral flow values of 18%. Using a threshold of CFI=30%, sufficient and insufficient collaterals could be diagnosed with 100% sensitivity and 93% specificity by IC Doppler, and 75% sensitivity and 92% specificity by IC pressure measurements. The agreement between Doppler and pressure measurements was good: CFIv=0.08 + 0.8 CFIp, r=0.80, p=0.0001.
Intracoronary flow velocity or pressure measurements during routine PTCA represent an accurate and, at last, quantitative method for assessing the coronary collateral circulation in humans.
本研究评估了两种使用冠状动脉内（IC）血流速度或压力测量来定量测量侧支循环的方法。
冠状动脉闭塞后心肌坏死的程度受侧支循环的显著影响。到目前为止，已有定性方法可用于评估人体冠状动脉侧支循环，因此限制了例如促进侧支循环发育的治疗方法的确切研究。
使用基于IC PTCA导丝的多普勒和位于狭窄远端的压力传感器，对51例拟行经皮冠状动脉腔内血管成形术（PTCA）治疗的冠状动脉狭窄患者进行了研究。在PTCA期间和之后同时测量主动脉压力、IC速度和狭窄远端压力，提供了用于计算侧支血流指数（CFIv和CFIp）的变量，这些指数将侧支血流表示为通过通畅血管的血流的一部分。将CFIv和CFIp与传统的侧支评估方法进行比较，其中包括PTCA时IC和体表心电图（ECG）上ST段变化>1mm。此外，还对CFIv和CFIp进行了相互比较。
在11例PTCA期间无心电图缺血迹象（侧支循环充足）的患者中，通过多普勒和压力导丝测定的相对侧支血流为46%。侧支循环不足的患者（n = 40）相对侧支血流值为18%。使用CFI = 30%的阈值，通过IC多普勒诊断侧支循环充足和不足的敏感性为100%，特异性为93%，通过IC压力测量的敏感性为75%，特异性为92%。多普勒和压力测量之间的一致性良好：CFIv = 0.08 + 0.8 CFIp，r = 0.80，p = 0.0001。
常规PTCA期间的冠状动脉内血流速度或压力测量是一种准确且最终可定量评估人体冠状动脉侧支循环的方法。
