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· 臨床研究·
作者單位:430022 武漢,華中科技大學(xué)同濟(jì)醫(yī)學(xué)院附屬協(xié)和醫(yī)院
超聲科(謝明星、王新房、呂清、楊婭、黃潤青、盧曉芳、楊亞利) ,心導(dǎo)管
室(王祥)
經(jīng)胸超聲冠狀動脈血流顯像技術(shù)評價支架術(shù)
前后冠狀動脈血流儲備的初步臨床應(yīng)用
謝明星 王新房 王祥 呂清 楊婭 黃潤青 盧曉芳 楊亞利
【摘要】 目的 探討經(jīng)胸超聲冠狀動脈血流顯像技術(shù)評估冠心病支架術(shù)前、后冠狀動脈血流儲備
(CFR)的價值。方法 28 例冠狀動脈前降支狹窄的冠心病患者對狹窄的冠狀動脈行經(jīng)皮冠狀動脈內(nèi)成形
術(shù)(PTCA)后各置入 1 枚支架。分別于術(shù)前、術(shù)后 72 h內(nèi) ,采用經(jīng)胸超聲多普勒冠狀動脈血流顯像技術(shù)檢
測左冠狀動脈前降支狹窄遠(yuǎn)端靜息舒張期血流峰速( r2Vd) 、注射潘生丁時最大舒張期血流峰速(d2Vd)及
CFR。結(jié)果 28 例患者行支架術(shù)均獲成功 ,狹窄率由術(shù)前 84. 2 % ±8. 6 %降至術(shù)后 5. 4 % ±0. 8 % ,( P < 0. 05) 。28 例患者共 40 支病變血管中 ,34 支狹窄冠狀動脈遠(yuǎn)端檢測到多普勒頻譜(檢出率 85 %) 。
支架術(shù)后 r2Vd較術(shù)前 r2Vd有增加趨勢 ,但差異無顯著性意義( P > 0. 05) ;術(shù)后靜脈注射潘生丁后最大 d2
Vd及 CFR均較術(shù)前明顯增加[ (0. 94 ±0. 21) m/ s 對(0. 51 ±0. 18) m/ s ,3. 21 ±1. 21 對 1. 89 ±0. 40 ,均
P < 0. 05 ]。結(jié)論經(jīng)胸超聲多普勒冠狀動脈血流顯像技術(shù)結(jié)合潘生丁試驗是一種簡便、易行、無創(chuàng)性評價
冠心病患者冠狀動脈介入治療前后血流儲備變化的新方法。
【關(guān)鍵詞】 超聲心動描記術(shù);血管成形術(shù) ,經(jīng)腔 ,經(jīng)皮冠狀動脈;支架;冠狀動脈血流儲備
Initial exploration on noninva sive a sse ssment of coronary flow re serve using transthoracic coronary flow
imaging before and after succe ssful coronary stent implantation XI E Ming2xing , WA N G Xin2f ang , WA N G
Xiang , et al . Department of Ul t rasound , Union Hospital , Tongji Medical College , Huaz hang University of
Science and Technology , Wuhan 430022 ,China
【Abstract】 Objective To estimate the value of t ransthoracic coronary flow Doppler imaging to detect
coronary flow velocity changes in patients undergoing coronary angioplasty and stenting and to assess coronary
flow reserve(CFR) of the procedure. Methods Twenty2eight patients with coronary vessel disease undergoing
stent implantion were studied with t ransthoracic pulsed Doppler guided by color flow imaging to record coronary
diastolic peak velocicy at rest (r2Vd) and < 72 hours after the interventional procedure. Re sults Coronary flow
velocity Doppler signals were successfully obtained in 34/ 40 narrowing coronary arteries (85 %) of 28 patients.
Narrowing percent in diameter for 28 LAD decreased f rom 84. 2 % ±8. 6 % before to 5. 4 % ±0. 8 % after
stenting ( P < 0. 05) . Both maximal d 2Vd and CFR significantly increased after stenting [ (0. 94±0. 21) m/ s vs
(0. 52±0. 18) m/ s , 3. 21 ±1. 21 vs 1. 89 ±0. 40 , P < 0. 05 ] . After stenting , r2Vd tended to increase [ (0. 36 ±
0. 18) m/ s vs (0. 24 ±0. 09) m/ s , P > 0. 05 ] . Impaired CFR after successful stenting (25 % ,7/ 28) was related
to an increased resting flow velocity. Patients with an increase of CFR after stenting were characterized by an
unaltered resting flow velocity and an increased dipyridamole2induced maximal flow velocity. Conclusions In
patients with coronary artery stenosis , t ransthoracic coronary flow imaging combined with int ravenous
dipyridamole shows improvement in CFR after successful stent implantation. This new method may be a feasible
and promising technique for assessing CFR with a real noninvasive approach.
【Key words】 Echocardiography ;Angioplasty , t ransluminal ,percutaneous coronary ; Stents ; Coronary flow
reserve
冠狀動脈血流儲備(coronary flow reserve ,CFR)
是臨床上評價冠狀動脈循環(huán)功能的一個有效指
標(biāo)[1 ,2 ]。既往主要采用有創(chuàng)性的昂貴檢查手段測量
CFR ,使其臨床應(yīng)用上受到限制[3 ,4 ]。超聲心動圖冠
狀動脈血流顯像技術(shù)是近年發(fā)展起來的一項評價冠狀
動脈血流速度變化的新技術(shù) ,其通過脈沖多普勒測量
冠狀動脈血流速度變化來評價 CFR[5 ]。本研究應(yīng)用
此項技術(shù)結(jié)合潘生丁試驗 ,觀察冠心病患者支架術(shù)前、后 CFR的改變 ,探討這一無創(chuàng)、簡便的檢測方法對評
價冠心病患者介入治療前后 CFR變化的應(yīng)用價值。
· 523 · 中華超聲影像學(xué)雜志2003 年6 月第12 卷第6 期 Chin J Ult rasonogr ,J une 2003 ,Vol 12 ,No. 6
? 1995-2005 Tsinghua Tongfang Optical Disc Co., Ltd. All rights reserved.資 料 與 方 法
一、研究對象
選擇支架術(shù)前經(jīng)本院或外院心血管造影有前降支
單處病變的心絞痛患者 28 例 ,男 21 例 ,女 7 例 ,年齡
40～63 歲 ,平均(54. 2 ±6. 9) 歲 ......
作者單位:430022 武漢,華中科技大學(xué)同濟(jì)醫(yī)學(xué)院附屬協(xié)和醫(yī)院
超聲科(謝明星、王新房、呂清、楊婭、黃潤青、盧曉芳、楊亞利) ,心導(dǎo)管
室(王祥)
經(jīng)胸超聲冠狀動脈血流顯像技術(shù)評價支架術(shù)
前后冠狀動脈血流儲備的初步臨床應(yīng)用
謝明星 王新房 王祥 呂清 楊婭 黃潤青 盧曉芳 楊亞利
【摘要】 目的 探討經(jīng)胸超聲冠狀動脈血流顯像技術(shù)評估冠心病支架術(shù)前、后冠狀動脈血流儲備
(CFR)的價值。方法 28 例冠狀動脈前降支狹窄的冠心病患者對狹窄的冠狀動脈行經(jīng)皮冠狀動脈內(nèi)成形
術(shù)(PTCA)后各置入 1 枚支架。分別于術(shù)前、術(shù)后 72 h內(nèi) ,采用經(jīng)胸超聲多普勒冠狀動脈血流顯像技術(shù)檢
測左冠狀動脈前降支狹窄遠(yuǎn)端靜息舒張期血流峰速( r2Vd) 、注射潘生丁時最大舒張期血流峰速(d2Vd)及
CFR。結(jié)果 28 例患者行支架術(shù)均獲成功 ,狹窄率由術(shù)前 84. 2 % ±8. 6 %降至術(shù)后 5. 4 % ±0. 8 % ,( P < 0. 05) 。28 例患者共 40 支病變血管中 ,34 支狹窄冠狀動脈遠(yuǎn)端檢測到多普勒頻譜(檢出率 85 %) 。
支架術(shù)后 r2Vd較術(shù)前 r2Vd有增加趨勢 ,但差異無顯著性意義( P > 0. 05) ;術(shù)后靜脈注射潘生丁后最大 d2
Vd及 CFR均較術(shù)前明顯增加[ (0. 94 ±0. 21) m/ s 對(0. 51 ±0. 18) m/ s ,3. 21 ±1. 21 對 1. 89 ±0. 40 ,均
P < 0. 05 ]。結(jié)論經(jīng)胸超聲多普勒冠狀動脈血流顯像技術(shù)結(jié)合潘生丁試驗是一種簡便、易行、無創(chuàng)性評價
冠心病患者冠狀動脈介入治療前后血流儲備變化的新方法。
【關(guān)鍵詞】 超聲心動描記術(shù);血管成形術(shù) ,經(jīng)腔 ,經(jīng)皮冠狀動脈;支架;冠狀動脈血流儲備
Initial exploration on noninva sive a sse ssment of coronary flow re serve using transthoracic coronary flow
imaging before and after succe ssful coronary stent implantation XI E Ming2xing , WA N G Xin2f ang , WA N G
Xiang , et al . Department of Ul t rasound , Union Hospital , Tongji Medical College , Huaz hang University of
Science and Technology , Wuhan 430022 ,China
【Abstract】 Objective To estimate the value of t ransthoracic coronary flow Doppler imaging to detect
coronary flow velocity changes in patients undergoing coronary angioplasty and stenting and to assess coronary
flow reserve(CFR) of the procedure. Methods Twenty2eight patients with coronary vessel disease undergoing
stent implantion were studied with t ransthoracic pulsed Doppler guided by color flow imaging to record coronary
diastolic peak velocicy at rest (r2Vd) and < 72 hours after the interventional procedure. Re sults Coronary flow
velocity Doppler signals were successfully obtained in 34/ 40 narrowing coronary arteries (85 %) of 28 patients.
Narrowing percent in diameter for 28 LAD decreased f rom 84. 2 % ±8. 6 % before to 5. 4 % ±0. 8 % after
stenting ( P < 0. 05) . Both maximal d 2Vd and CFR significantly increased after stenting [ (0. 94±0. 21) m/ s vs
(0. 52±0. 18) m/ s , 3. 21 ±1. 21 vs 1. 89 ±0. 40 , P < 0. 05 ] . After stenting , r2Vd tended to increase [ (0. 36 ±
0. 18) m/ s vs (0. 24 ±0. 09) m/ s , P > 0. 05 ] . Impaired CFR after successful stenting (25 % ,7/ 28) was related
to an increased resting flow velocity. Patients with an increase of CFR after stenting were characterized by an
unaltered resting flow velocity and an increased dipyridamole2induced maximal flow velocity. Conclusions In
patients with coronary artery stenosis , t ransthoracic coronary flow imaging combined with int ravenous
dipyridamole shows improvement in CFR after successful stent implantation. This new method may be a feasible
and promising technique for assessing CFR with a real noninvasive approach.
【Key words】 Echocardiography ;Angioplasty , t ransluminal ,percutaneous coronary ; Stents ; Coronary flow
reserve
冠狀動脈血流儲備(coronary flow reserve ,CFR)
是臨床上評價冠狀動脈循環(huán)功能的一個有效指
標(biāo)[1 ,2 ]。既往主要采用有創(chuàng)性的昂貴檢查手段測量
CFR ,使其臨床應(yīng)用上受到限制[3 ,4 ]。超聲心動圖冠
狀動脈血流顯像技術(shù)是近年發(fā)展起來的一項評價冠狀
動脈血流速度變化的新技術(shù) ,其通過脈沖多普勒測量
冠狀動脈血流速度變化來評價 CFR[5 ]。本研究應(yīng)用
此項技術(shù)結(jié)合潘生丁試驗 ,觀察冠心病患者支架術(shù)前、后 CFR的改變 ,探討這一無創(chuàng)、簡便的檢測方法對評
價冠心病患者介入治療前后 CFR變化的應(yīng)用價值。
· 523 · 中華超聲影像學(xué)雜志2003 年6 月第12 卷第6 期 Chin J Ult rasonogr ,J une 2003 ,Vol 12 ,No. 6
? 1995-2005 Tsinghua Tongfang Optical Disc Co., Ltd. All rights reserved.資 料 與 方 法
一、研究對象
選擇支架術(shù)前經(jīng)本院或外院心血管造影有前降支
單處病變的心絞痛患者 28 例 ,男 21 例 ,女 7 例 ,年齡
40～63 歲 ,平均(54. 2 ±6. 9) 歲 ......
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