冠状动脉内超声与冠状动脉造影引导支架置入预后的比较
作者：韩 丁 朱文玲 黄超联
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目的 目的：评价有引起冠状动脉微血管病变疾病基础和无引起冠状动脉微血管病变基础，但冠状动脉造影正常患者的冠状动脉血流储备功能的差别。
方法：冠状动脉造影正常患者27例，男18例，女9例，平均年龄56.89±9.20岁。采用冠状动脉内多普勒导丝检查技术测定65支冠状动脉的近、远端平均峰速(APV)、舒张期与收缩期流速比(DSVR)、冠状动脉血流储备(CFR)和近端与远端流速比(P/DVR)。研究分为两组，A组为有冠状动脉微血管病变基础者，包括高血压和(或)糖尿病和心肌病患者，共20例，48支冠状动脉(前降支17支，回旋支16支，右冠状动脉15支)。B组为无冠状动脉微血管病变基础者(正常对照)，共7例，17支冠状动脉(包括前降支7支，回旋支3支，右冠状动脉7支)。
结果：A组CFR明显较B组小(2.48±0.69比3.19±0.65)(P<0.001),A组近、远端APV较B组增高(20.14±6.39 cm/s比16.33±4.75 cm/s和19.05±6.46 cm/s比15.39±6.29 cm/s，P<0.05),DSVR及P/DVR两组间无显著差别(P>0.05)。以CFR>2.0为正常标准值，则A组中37/48支冠状动脉(77%)CFR正常(A1组)，11/48支冠状动脉(23%)CFR异常(A2组)，而B组17支冠状动脉的CFR均大于2.0。A1与A2两组比较，除A2组充血相APV增加明显小外(36.11±15.56 cm/s比47.51±13.39 cm/s,P<0.05),其它指标间未见有意义的差别(P>0.05)。B、A1及A2 3组比较，CFR依次降低，差别显著，分别为3.19±0.65,2.63±0.58,1.16±0.47(P均<0.05);远端基础APV分别为15.39±6.29 cm/s,18.14±5.43 cm/s,22.10±8.59 cm/s,B组明显低于A1及A2组(P<0.05);充血相APV分别为46.32±14.08 cm/s,47.51±13.39 cm/s,36.11±15.56 cm/s,A2组明显低于其他两组(P<0.05)。
结论：有冠状动脉微血管病基础的患者，尽管冠状动脉造影正常，其CFR明显低于无冠状动脉微血管病变基础的患者；有冠状动脉微血管病变基础的冠状动脉中，232%检出CFR的异常(<2.0),CFR降低的原因可能与冠状动脉充血反应能力下降和(或)基础AVP增加有关。
Coronary Flow Reserve Evaluated with Doppler Flow Wire in Patients
with Normal Coronary Angiogram (Abstract)
Department of Cardiology, Zhong Shan Hospital of Shanghai Medical University
and Shanghai Institute of Cardiovascular Diseases, Shanghai (200032)
Wei Meng, Shao Zhili, Shen Xuedong, et al.
Objective: To evaluate coronary flow reserve (CFR) in patients with normal coronary angiogram with Doppler flow wire, comparing the CFR in patients who have microcornary artery disease basis (e.g. underlying hypertension and/or diabetes and cardiomyopathy with that in patients who have not.
Methods: Twenty-seven patients (18 males, 9 females, mean age 56.89±9.20 years) with normal coronary angiogram were studied. 65 coronary arteries (LAD 24, LCX 19 and RCA 22) were examined with Doppler flow wire. The patients were divided into two groups: group A had 20 patients (48 arteries, including LAD 17, LCX 16, RCA 15) with hypertension and/or diabetes and cardiomyopathy; group B had 7 patients (17 arteries, including LAD 7, LCX 3, RCA 7) without underlying diseases of microcoronary artery as normal controls. The measurements included proximal and distal average peak velocity (APV), diastolic and systolic velocity ratio (DSVR), coronary flow reserve (CFR) and proximal and distal velocity ratio (P/DVR).
Results: CFR in group A was significantly lower than it in group B (2.48±0.69 vs. 3.19±0.65, p<0.001). The basic proximal and distal APV in group A were significantly higher than it in group B (20.14±6.39 cm/s vs. 16.33±4.75 cm/s and 19.05±6.46 cm/s vs. 15.39±6.29 cm/s respectively, all p<0.05). Differences in DSVR and P/DVR between the two groups were insignificant (all (p>0.05). While the normal value of CFR was assigned as >2.0, CFR in 37 of 48 arteries (77%) in group A were normal (group A1), and in 11 of 48 arteries (23%) were abnormal (group A2), however CFR in group B were all greater than 2.0. All parameters between group A1 and A2 had no significant difference (p>0.05) except hyperemic APV which showed remarkably lower in group A2 than in group A1 (36.11±15.56 cm/s vs. 48.06±13.42 cm/s, p<0.05). CFRs in group B, A1 and A2 were 3.19±0.65, 2.63±0.58 and 1.16±0.47 respectively, there were significant differences among the three groups (p<0.05); basic APVs in group B, A1 and A2 were 15.39±6.29 cm/s, 18.14±5.43 cm/s and 22.10±8.59 cm/s respectively, it in group B was significantly lower than it in the other groups (p<0.05); hyperemic APVs in group B, A1 and A2 were 46.32±14.08 cm/s, 47.51±13.39 cm/s, 36.11±15.56 cm/s, respectively, it in group A2 was significantly lower than it in the other groups (p<0.05).
Conclusion: CFR in patients with normal coronary angiograms, as well as with basis of microcoronary artery disease was remarkably lower than it in those without basis of microcoronary artery disease. Seriously impaired CFR (<2.0) was found in 23% of coronary arteries in patients with basis of microcoronary artery disease, decreased CFR may be caused by impaired microcoronary artery dilatation response and/or accelerated basic APV.