冠状动脉血流储备的临床应用

首都医科大学附属北京安贞医院首都医科大学附属北京安贞医院 Anzhen HospitalAnzhen Hospital Capital Medical University Capital Medical University Clinical Application of Coronary flow Reserve in Echocardiography 冠状动脉血流储备的临床应用 杨 娅 首都医科大学附属北京安贞医院 Coronary Flow Reserve, CFR 冠状动脉血流储备 nCFR was assessed as the ratio of peak hyperemic to basal coronary flow nCFR=CFh/CFb nCFVR=CFVh/CFVb n冠状动脉血流储备最大冠脉血流与静息冠脉血流的 比值,即最大冠状动脉扩张状态下的冠脉血流与静息 状态下冠脉血流的比值 Coronary Flow 冠状动脉血流 nIntracoronary Doppler Flow (ICD) 冠状动脉内多普勒血流 “Gold-standard“ method Invasive method nCoronary flow Imaging(CFI)-Transthoracic Doppler Echocardiography (TTDE) 冠状动脉血流显像经胸多普勒超声心动图 Coronary flow Imaging(CFI) Transthoracic Doppler echocardiography (TTDE) 冠状动脉血流显像经胸多普勒超声心动图 LAD 正常LAD中段 LAD Adenosine Stress-Echo腺苷负荷试验 Rest 基础状态 140gkg-1min-1 CFV 冠脉血流速度 3min CFV 冠脉血流速度 Rest 基础状态 50 g75 g100 g 140 g 1min 1min1min3min 注入腺苷后所致的心率、血压及平均血流速度的变化 Regression analysis of APV-values: TTDE vs. ICD TTDE探测CFVR的准确性 Regression analysis of APV-values: TTDE vs. ICD TTDE探测CFVR的准确性 Regression analysis of CFVR: TTDE vs. ICD TTDE探测CFVR的准确性 冠状动脉狭窄 Coronary Stenosis H Lambertz et al. J Am Soc Echo 1999,12:186-95Coronary Stenoses冠状动脉狭窄 CFVR=1.3 CFVR=2.8 CFVR=3.3 冠状动脉介入治疗的效果并追踪随访 以ICD探测的CFVR2.5为判断CFVR受损的切断点， TTDE的敏感性和特异性分别为92.31%和88.46% Microvascular Dysfunction 正常冠脉-微循环受损 Microvascular Dysfunction Hypertrophic Cardiomyopathy 肥厚型心肌病 肥厚型心肌病 Coronary Flow in Patients with Hypertension 高血压患者与正常人冠脉血流参数的比较 Coronary Flow in Patients with Hypertension 高血压患者的CFVR变化 CFVR and LV Diastolic Function CFVR与舒张功能的关系 A: HTN (n=30)B: Without HTN HTN (reduced CFR) HTN (normal CFR) n141614 CFR2.14 0.433.51 0.383.35 0.42 DD14(100%)10(37.5%)5(35.7%) LVEDP(mmHg)19 4.415 3.614 4.1 E/A0.8 0.11.3 0.61.2 0.4 CFVR in Patients with Familial Hypercholesterolemia(FH) FH患者CFVR的变化 组别 MDVb(cm/s） MDVh(cm/s） CFVR FH 36.8925.75 72.3035.142.300.85 对照组 control 20.283.65 63.039.823.120.22 CFVR of FH group was lower than control group significantly CFVR减低 SUMMERY 小结 nClinical Application of Coronary Flow Imaging Coronary Stenosis Follow-Up after PTCA Hypertrophic Cardiomyopathy Hypertension Microvascular disease n