张红安, 唐静, 张乙慧. 无创性冠脉血流储备用于分析不稳定型心绞痛患者冠脉缺血和冠脉狭窄的关系[J]. 心脏杂志, 2019, 31(5): 561-564, 568. DOI: 10.12125/j.chj.201904017
    引用本文: 张红安, 唐静, 张乙慧. 无创性冠脉血流储备用于分析不稳定型心绞痛患者冠脉缺血和冠脉狭窄的关系[J]. 心脏杂志, 2019, 31(5): 561-564, 568. DOI: 10.12125/j.chj.201904017
    Hong-an ZHANG, Jing TANG, Yi-hui ZHANG. Non-invasive coronary flow reserve for evaluating relationship between myocardial ischemia and coronary stenosis in patients with unstable angina pectoris[J]. Chinese Heart Journal, 2019, 31(5): 561-564, 568. DOI: 10.12125/j.chj.201904017
    Citation: Hong-an ZHANG, Jing TANG, Yi-hui ZHANG. Non-invasive coronary flow reserve for evaluating relationship between myocardial ischemia and coronary stenosis in patients with unstable angina pectoris[J]. Chinese Heart Journal, 2019, 31(5): 561-564, 568. DOI: 10.12125/j.chj.201904017

    无创性冠脉血流储备用于分析不稳定型心绞痛患者冠脉缺血和冠脉狭窄的关系

    Non-invasive coronary flow reserve for evaluating relationship between myocardial ischemia and coronary stenosis in patients with unstable angina pectoris

    • 摘要:
        目的  探究无创性冠脉血流储备(coronary flow reserve,CFR)用于分析不稳定型心绞痛(UAP)患者心肌缺血和冠脉狭窄关系。
        方法  选取2016年1月至2018年12月收入UAP患者180例,共计冠脉病变94支,冠脉血流显像模式开展下,获取前降支、回旋支及右冠脉中远端静息时血流频谱图,ATP注射前、停药后5min内冠脉扩张后血流频谱图获取,用于测定静息状态下最大冠状舒张时峰值流速,并计算CFR。结果 冠脉狭窄组CFR为(1.17 ± 0.21),非冠脉狭窄组为(2.61 ± 0.32),冠脉狭窄组显著低于非冠脉狭窄组,差异具有统计学意义(P < 0.01);CFR ≤ 1.8诊断为冠脉狭窄,敏感度为98%(92/94)、特异度为99%(85/86),准确度为98%(177/180)。冠脉狭窄率 > 70%,CFR为(0.84 ± 0.12),冠脉狭窄率50%~70%,CFR为(1.91 ± 023),差异具有统计学意义(P = 0.01),CFR以1.0作为截断值,冠脉狭窄率 > 70%,CFR ≤ 1.0例数为35例,冠脉狭窄率50%~70%,CFR ≤ 1.0例数为5例,差异具有统计学意义(P < 0.01),当冠脉狭窄率增高,则CFR减低,二者呈负相关(r = −0.803,P<0.05)。两组左心室舒张、收缩功能指标比较差异均无统计学意义。Pearson相关分析结果显示CFR与各心脏功能指标无相关性。与用药前比较,给药5 min、停药5 min后心率、收缩压、舒张压、呼吸高于用药前,差异有意义(P < 0.05, P < 0.01)。
        结论  UAP患者开展无创CFR,可用于评估冠脉狭窄及其严重程度,但是冠状狭窄和患者心肌缺血发生并无明显相关性。

       

      Abstract:
        AIM  To explore the relationship between myocardial ischemia and coronary stenosis in patients with unstable angina pectoris by non-invasive coronary flow reserve (CFR).
        METHODS  Sixty patients with unstable angina pectoris were selected from January 2016 to December 2018 in our hospital. A total of 94 diseased coronary arteries were examined by coronary flow imaging. The blood flow spectrograms of anterior descending, circumflex and middle and distal right coronary arteries at rest were obtained. The blood flow spectrograms were obtained before ATP injection and within 5 minutes after ATP withdrawal to measure the maximum peak coronary diastolic flow velocity at rest, and CFR was calculated.
        RESULTS  The cutoff value for CFR was at 2.0. When CFR<2.0 indicated myocardial ischemia, the analysis of non-invasive CFR and coronary angiography showed that CFR decreased significantly with the increase of coronary stenosis rate and there was a negative correlation between them (r = −0.803, P<0.05). CFR was less than 2.0 in 40 lesions of coronary artery and > 2.0 in 54 diseased coronary arteries. The results suggested that the sensitivity of CFR < 2.0 to predict coronary stenosis rate > 70% was 82.7%, the specificity was 87.7%, the positive predictive value was 84.2%, the negative predictive value was 86.5, the number of single vessel lesions was 61, the number of double vessel lesions was 21 and the number of three vessel lesions was 12. Compared with those before treatment, the heart rate, systolic blood pressure, diastolic blood pressure and respiration after 5 minutes of administration and 5 minutes of withdrawal were higher and the difference was significant (P < 0.05, P < 0.01).
        CONCLUSION  Noninvasive CFR is useful to assess the severity of myocardial ischemia and its relationship with coronary stenosis in patients with unstable angina pectoris.

       

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