(Coronary flow reserve,cfr) onary Flow Velocity Reserve,CFVR) CFR CFVR

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1 J Ultrasound in Clin Med,March 2006, Vol. 8, NO (CFI),,, 34,Π 19,;15,(CFVR, ), 34 CFVR CFVR ( vs , P < 0. 05), CFVR ;,,; CFVR ;; The clinical research of the measurement of coronary flow reserve by noninvasive coronary flow imaging in patients with angiographically normal coronary arteries Yang Ya,Li Zhian,Wang Lijun Department of Ultrasound,Anzheng Hospital affialited to Capital medical university,beijing ,China ABSTRACT Objective To validate the feasibility of the measurement of coronary flow velocity reserve (CFVR) by noninvasive coronary flow imaging (CFI) and to evaluate the CFVR in patients who had chest pain and angiographically normal coronary arteries by this method. Methods CFVR was measured in the distal left anterior descending artery (LAD) in 34 subjects with angiographically nor2 mal coronary arteries, including 19 patients with chest pain and 15 normal control subjects by CFI at baseline and hyperemic conditions (intravenous administration of adenosine 140g. kg - 1. min - 1 ). CFVR was defined as the ratio of hyperemic to basal mean diastolic ve2 locity. Coronary flow velocity and CFVR were studied in 19 patients and compared to 15 normal subjects.results CFVR was success2 fully measured in 34 subjects. In 19 patients, CFVR of LAD was lower than control subjects ( vs , P < 0. 05). There was no significant difference of coronary flow velocity both at baseline and hyperemic conditions in patients and normal control sub2 jects. Conclusion Noninvasive CFI combined with adenosine stress experiment provides a reliable measurement of CFVR in the distal left anterior descending artery. CFVR is impaired in patients with chest pain and angiographically normal coronary arteries. Hypertension and hyperlipidemia are the reasons of the reduction of CFVR. KEY WORDS coronary flow imaging ;coronary flow reserve ;Coronary angiography (Coronary flow reserve,cfr),,,, (Cor2 onary Flow Velocity Reserve,CFVR) CFRCFVR [1 ],CFVR CFR [2 ] CFVR :( ) :100029,

2 J Ultrasound in Clin Med,March 2006, Vol. 8, NO. 3 [1 ],,,, (CFI),,CFVR,,,10 %30 %,,,CFVR [3 ],,CFR [4. 5 ] [6 ],,CFR CFVR,, CFVR CFI CFVR,, CFI CFVR, 34 19,11,8, 4167, ( ),( 140Π90 mm Hg) Π ( 230 mgπml Π 160 mgπml), ;15,9, 6, 2075, ( ),,, Sequoia C 256 Vivid 7, (LAD), LAD LAD LAD > 30, LAD,,140g kg - 1 min min,,, LAD, (bpdv) (bmdv) ( hpdv) (hmdv),cfvr,cfvr = hmdvπbmdv SPSS 11. 0,,t, P < CFI CFVR 34,,CFVR 100 %, 12 min, (1) 1 ( %) ,, (2) bpdv bmdv,

3 J Ultrasound in Clin Med,March 2006, Vol. 8, NO ;hmdv, ; CFVR, (3) 2 (Πmin) (mm Hg) (mm Hg) P P < P > P > ( gx s) bpdv(cmπs) hpdv(cmπs) bmdv(cmπs) hmdv(cmπs) CFVR P P > P > P > P > P < CFI, CFVR, CFI CFVR,,,,, Hozumi [7 ],CFI ( ICD) CFVR, CFI CFVR,,CFI,, 90 % [8 ],,CFI 95 %100 % [9 ],CFVR, 100 % CFVR,,,,, 68 min,,, 30 min,,, [10 ],,,,, ( < 10 s),2 min,,, 12 min,,cfvr,, 140 g kg - 1 min - 1, 23 min CFVR,, 6 min,31 6 min,3 6 min, 2 min,, 12 min,, CFVR,, CFVR,,,,,, Erbel [3 ] 44 ICD,16 (36 %),CFVR > 3. 0, [11 ] CFVR, CFVR,, CFVR, ICD,

4 J Ultrasound in Clin Med,March 2006, Vol. 8, NO. 3,CFVR [12 ] CFVR,, CFVR,,,CFVR > 3. 0 [13 ],CFI ICD CFVR,ICD CFVR 3. 0,CFI CFVR % 8010 %, CFVR 3. 0,,,,CFVR [12 ], [4. 5 ] [14 ] ICD CFVR,,, 16 %CFVR,CFVR Vokoyama [4 ], CFVR,19,,CFVR, CFVR,,, [15 ] CFVR [4 ],,,,,Fuji2 moto [16 ],16 Fluvastatin 3,, CFVR ( ) ( ),,,, [17 ],CFVR,,,,, [18 ],,CFVR,,CFVR < 2, CFVR CFVR,,CFVR CFR [2 ],,CFVR CFR [13 ] CFI LAD,,30,,CFVR : CFVR () () CFVR [12,19 ] ICD,CFI CFVR,,,, CFVR, ; CFVR ;,, ; CFVR 1 Gould KL, Lipscomb K, Hamilton GW. Physiologic basis for assessing criti2 cal coronary stenosis : Instantaneous flow response and regional distribution during coronary hyperemia as measures of coronary flow reserve. AmJ Cardi2 ol, 1974, 33 : Doucette JW, Corl PD, Payne HM, et al. Validation of Doppler guide wire for intravascular measurement of coronary artery flow velocity. Circulation, 1992, 85 : Erbel R, Ge J, Bockisch A, et al. Value of intracoronary ultrasound and Doppler in the differentiation of angiographically normal coronary arteries : a prospective study in patients with angina pectoris. Eur Heart J, 1996,17 : Yokoyama I, Ohtake T, Momomura S, et al. Reduced coronary flow reserve in hypercholesterolemic patients without overt coronary stenosis. Circulation, 1996, 94 :

5 J Ultrasound in Clin Med,March 2006, Vol. 8, NO Antony I, Nitenberg A. Coronary flow reserve is similarly reduced in hyper2 tension patients without any other coronary risk factors and in normotension smokes and hypercholesterolemic patients with angiographically normal coro2 nary arteries. Am J Hypertens, 1997,10 : Garot P, Teiger E, Pupouy P, et al. Coronary microcirculation and cardio2 vascular pathology Drugs, 1999, 58 : Hozumi T, Yoshida K, Akasaka T, et al. Noninvasive assessment of coro2 nary flow velocity and coronary flow velocity reserve in the left anterior de2 scending coronary artery by Doppler echocardiography. Comparison with inva2 sive technique. J Am Coll Cardiol, 1998, 32 : Youn HJ, Foster E. Demonstration of coronary artery flow using transthoracic Doppler echocardiography. J Am Soc Echocardiogr, 2004, 17 : Winter R, Gudmundsson P, Willenheimer R. Feasibility of noninvasive tran2 sthoracic echocardiography ΠDoppler measurement of coronary flow reserve in left anterior descending coronary artery in patients with acute coronary syn2 drome : a new technique tested in clinical practice. J Am Soc Echocardio2 graphy, 2003, 16 : Hori M, Kitakaze K. Adenosine, the heart and coronary circulation. Hyper2 tension, 1991, 18 : , Bartel T,,. :., 2004, 20 : White CW. Clinical applications of Doppler coronary flow reserve measure2 ments. Am J Cardial, 1993 ; 71 : , Bartel T,,.., 2002,11 : ,,,.., 1999,15 : Schwartzkopff B, Motz W, Frenzel H, et al. Structure and functional alter2 ations of the intramyocardial coronary arterioles in patients with arterial hy2 pertension. Circulation, 1993, 88 : Fujimoto K, Hozumi T, Watanabe H, et al. Effect of Fluvastatin therapy on coronary flow reserve in patients with hypercholesterolemia. Am J Cardiol, 2004, 93 : ,,,.., 2000,8 : ,,,.., 2000, 39 : McGinn A, White CW, Wilson RF. Interstudy variability of coronary flow reserve : influence of heart rate, arterial pressure and ventricular preload. Circulation, 1990, 81 : ( : ) B 1,,69 5,, B, Acuson 128XPΠ10, 3. 5 MHzB : 95 mm 49 mm 52 mm, 95 mm 44 mm 53 mm38 mm 25 mm 30 mm,,, 22 mm 27 mm, 11 mm 14 mm(1), : ; :,,,,, 1,,,,,,,, ( : ) :510282,

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