CAJ | 학술논문

目的评价冠脉内多普勒血流速度描记在冠脉造影正常、中度狭窄和重度狭窄患者定量冠脉血流储备的价值.方法采用美国Cardiometrics FloMapⅡ超声诊断仪和直径0.014英寸或0.018英寸血流速度描记钢丝,对55例行冠脉造影的患者分四组研究:甲组为7例冠脉造影正常且无冠脉微循环病变基础的患者;乙组为20例冠脉造影正常但有冠脉微循环病变基础的患者;丙组为12例冠脉造影示中度狭窄(30%～70%)的患者,丁组为16例冠脉造影示重度狭窄(>70%)的患者.结果乙组冠脉远端基础状态下平均峰速(APV)较甲组增高(P<0.05),但远端峰值APV的差别无显著意义(P>0.05),故乙组冠脉血流储备(CFR)明显低5于甲组(P<0.0005).以CFR>2.0为标准判断CFR正常,发现乙组37支冠脉(77%)CFR正常,11支冠脉(23%)CFR异常.乙组CFR异常的11支冠脉中,7支(63.64%)在左室肥厚者.丙组CFR较甲组小[(2.025=0.48)vs(3.195=0.65),P<0.001].丁组CFR与甲组间的差别更大[(1.50±1.01)vs(3.19±0.65),P<0.005],且充血反应时APV明显较小[(21.69±16.28)vs(46.32±1408),P<0.001].结论造影正常而有微血管病变基础的冠脉中,23%CFR异常.与正常对照组相比,狭窄冠脉远端CFR明显降低,随着冠脉狭窄程度增加,CFR进一步下降.
목적 평개관맥내다보륵혈류속도묘기재관맥조영정상、중도협착화중도협착환자정량관맥혈류저비적개치.방법 채용미국Cardiometrics FloMapⅡ초성진단의화직경0.014영촌혹0.018영촌혈류속도묘기강사,대55례행관맥조영적환자분사조연구:갑조위7례관맥조영정상차무관맥미순배병변기출적환자;을조위20례관맥조영정상단유관맥미순배병변기출적환자;병조위12례관맥조영시중도협착(30%～70%)적환자,정조위16례관맥조영시중도협착(>70%)적환자.결과 을조관맥원단기출상태하평균봉속(APV)교갑조증고(P<0.05),단원단봉치APV적차별무현저의의(P>0.05),고을조관맥혈류저비(CFR)명현저5우갑조(P<0.0005).이CFR>2.0위표준판단CFR정상,발현을조37지관맥(77%)CFR정상,11지관맥(23%)CFR이상.을조CFR이상적11지관맥중,7지(63.64%)재좌실비후자.병조CFR교갑조소[(2.025=0.48)vs(3.195=0.65),P<0.001].정조CFR여갑조간적차별경대[(1.50±1.01)vs(3.19±0.65),P<0.005],차충혈반응시APV명현교소[(21.69±16.28)vs(46.32±1408),P<0.001].결론 조영정상이유미혈관병변기출적관맥중,23%CFR이상.여정상대조조상비,협착관맥원단CFR명현강저,수착관맥협착정도증가,CFR진일보하강.
Objective To evaluate the intracoronary Doppler flowire in coronary arteries with or without stenosis.Methods 55 patients with coronary angiography were studied by Cardiometrics FloMap Ⅱ uItrasound instrument and 0.014 inch flowire.The patients were divided into four groups.Group A consisted of 7 padents without underlying diseases of coronary microvascular lesions and with normal angiography Group B Consisted of 20 patients with underlying diseases of coronary microvascular lesions including hypertension 16,hypertension combined with diabetes 2,and eardiomyopathy 2.Group C consisted of 12 patients with moderate stenosis(30%～70% diameter narrowing in angiography).Group D consisted of 16 patients with severe stenosis (>70% diameter narrowing in angiography).The measurements included distal baseline average peak veloeity (APV),hyperemic APV and flow reserve(CFR).Results The baseline APV in group B was higher than group A[(19.05±6.46)vs(15.39±6.29),P<0.05],so CFR in group B was significantly lower than group A[(2.48±0.69)vs(3.19±0.65),P<0.0005].To assess the difference of APV between patients with normal and abnormal CFR in group B,CFR>2.0 was determined as normal CFR criteria according to group A.CFR was normal in 37 arteries(77%),and 11 arteries(23%)was abnormal.Among the 11 abnormal CFR arteries,7 arteries(63.64%)with left ventricular hypertrophy.Compared with group A,CFR in distal arteries had significantly decreased in group C[(2.02±0.48)vs (3.19±0.65),P<0.001],CFR had further deterioration in group D[(1.50±1.01) vs (3.19±0.65),P<0.005].significantly lower hyperemic APV was also observed in group D[(21.69±16.28) vs (46.32±14.08),P<0.001].Concluslons Although the coronary angiography was normal in patients with underlying diseases of coronary microvascular lesions,23% arteries had abnormal CFR.Compared with norreal coronary control,CFR was further decreased with increassing severity of senosed coronary arteries.