冠脉内多普勒血流速度描记评价高血压病患者冠脉微循环功能
作者：邵志丽 沈学东 魏 盟 潘翠珍 钱菊英 戎卫海 王齐冰 林佑善 陈灏珠
单位：200032 上海医科大学中山医院，上海市心血管病研究所
关键词：冠脉内多普勒血流速度描记；冠脉血流储备；高血压病
中国超声医学杂志990112
摘 要 目的：探讨冠脉内多普勒血流速度描记评价高血压病患者冠脉微循环功能的价值。方法：我们对26例行冠脉造影的患者进行研究,男17例，女9例，年龄55.08±9.37岁,其中18例为高血压病患者(合并糖尿病2例，合并冠心病2例)。将高血压病患者中冠脉造影正常的43支冠脉列为甲组,包括前降支16支,回旋支13支,右冠脉14支。另8例无高血压病等冠脉微血管病变基础者,共19支冠脉为乙组(对照组),包括前降支8支,回旋支3支,右冠脉8支。用Cardiometrics Flomap II和0.014英寸多普勒钢丝测量：近端及远端平均峰速(APV)、舒张期与收缩期流速比(DSVR)、血流储备(CFR)和近端与远端流速比(P/DVR)。结果:甲组冠脉远端CFR明显较乙组小(2.61±0.68比3.09±0.68，p＝0.012),冠脉近端甲组血流频谱舒张期优势的特征不如乙组明显,表现为DSVR小于乙组(1.05±0.33比1.44±0.72，p＝0.0094)；而冠脉远端血流频谱舒张期优势的特征两组相似(p>0.05)。甲组近端APV显著高于乙组(p＝0.027),但甲、乙两组冠脉远端基础状态及峰值APV均无显著差异(p>0.05)。冠脉近端和远端血流速度比值的差别也无显著意义(p>0.05)。为了进一步评价甲组血流储备,以CFR>2.0为标准判断CFR正常,发现36支冠脉(84%)CFR正常,7支冠脉(16%)CFR异常。与CFR正常组相比,CFR异常组基础APV较大(25.27±9.79cm/s比18.80±7.20cm/s,p＝0.046),充血反应时APV无显著差别(42.53±16.99cm/s比48.77±13.38cm/s，p＝0.286),而P/DVR和DSVR未见有意义的改变(p>0.05)。结论：高血压病患者冠脉血管造影正常者中仍有16%的冠脉血流储备异常。
, 百拇医药
Evaluation of Coronary Microcirculation Function by Intracoronary
Doppler Flowire in Patients with Hypertension
Shao Zhili,Shen Xuedong,Wei Meng,et al
Shanghai Institute of Cardiovascular Diseases,Zhongshan Hospital,Shanghai Medical University,Shanghai 200032
ABSTRACT Objective:To evaluate the coronary microcirculation function in patients with hypertension.Method:coronary flow reserve(CFR)were measured in 26 patients with angiography(17 male,9 female,mean ages 55.08±9.37 years)by Cardiometrics Flomap Ⅱ Ultrasound Instrument and 0.014 inch flowire.The patients were divided into two groups:Group A consisted of 18 hypertensive patients(2 combined with diabetes,2 combined with coronary heart disease),43 arteries with normal angiography were studied by Doppler flowire,including LAD 16 arteries,LCX 13 arteries and RCA 14 arteries.Group B consisted of 8 patients without underlying diseases of coronary microvascular lesions,19 arteries were studied by Doppler flowire,including LAD 8 arteries,LCX 3 arteries and RCA 8 arteries.The proximal and distal average peak velocity(APV),diastolic/systolic velocity ratio(DSVR),coronary flow reserve(CFR)and proximal/distal velocity ratio(P/DVR)were measured.Results:CFR in group A was significantly lower than group B(2.61±0.68 versus 3.09±0.68，p＝0.012).DSVR at proximal coronary artery in group A was less than group B(1.05±0.33 versus 1.44±0.72，p＝0.0094)，which means that the superiority feature of flow pattern in diastole in group A was less than group B.However,at distal coronary artery,the superiority feature of flow pattern in diastole in group A was as the same as group B(p>0.05).APV at the proximal coronary artery in group A was much higher than group B (p＝0.027).To further evaluate CFR in group A,CFR>2.0 was determined as normal CFR criteria according to group B.36 arteries(84%)had normal CFR,and 7 arteries(16%)had abnormal.Comparing with normal CFR group,the baseline APV in abnormal CFR group was higher(25.27±9.79vs.18.80±7.20,p＝0.046)and hyperemic APV was not significantly lower(42.53±16.99vs.48.77±13.38,p＝0.286).P/DVR and DSVR had no significant changes(p>0.05).Conclusion:Although the coronary angiography might be normal in the patients with hypertension,16% arteries had abnormal CFR.
, 百拇医药
KEY WORDS Intracoronary Doppler flowire Hypertension Coronary flow reserve
多普勒血流速度描记评价冠状动脉(冠脉)生理功能是安全可靠的方法〔1〕。该技术不仅可用于测定血流速度还能用于测定冠脉血流储备(CFR)。在无冠脉狭窄的情况下，CFR可反映冠脉的微血管功能。本研究旨在评价多普勒血流速度描记在高血压病患者冠脉微血管功能的应用价值。
资料与方法
研究对象 为26例冠脉造影正常或部分正常的患者，男17例，女9例，年龄55.08±9.37岁。其中18例为高血压病患者(合并糖尿病2例，合并冠心病2例)。将冠脉造影正常的43支冠脉列为甲组，包括前降支16支，回旋支13支，右冠脉14支。另有8例无高血压病等冠脉微血管病变基础者，共19支冠脉被列为乙组(对照组)，包括前降支8支，回旋支3支，右冠脉8支。
, http://www.100md.com
仪器 采用美国Cardiometrics FloMap Ⅱ超声诊断仪和直径0.014英寸(0.036cm)或0.018英寸(0.046cm)易弯曲血流速度描记钢丝。该网丝长175cm，频率12MHz或15MHz，声束扩散角14°，取样容积距换能器5.2mm，纵向直径0.65mm，横向直径约2.25mm。来自冠脉的回声信号经快速富利叶转换，以连续的流速频谱显示(包括流速趋势显示)，并可记录和打印〔2〕。
操作 多普勒血流速度测定均在冠脉造影后进行，经Jodkins大腔导管送入多普勒钢丝至冠脉近端和远端，分别记录冠脉近端和远端的平均峰值流速(APV)，仪器可自动得出舒张期与收缩期冠脉流速比(DSVR)，近端与远端血流血速度之比(P/DVR)。最后将多普勒钢丝留置于冠脉远端，冠脉内注入12mg罂粟碱，测定充血反应达到峰值时APV。峰值与基础APV之比即为冠脉血流储备(CFR)〔2～5〕。
结 果
, 百拇医药
本组31例冠脉造影者均获得满意的冠脉内血流速度测定，无一例发生与血流速度测定有关的心律失常、冠脉痉挛、栓塞或穿孔等并发症。甲、乙两组的流速指标见附表。
如表所示,冠脉近端甲组血流频谱舒张期优势的特征不如乙组明显,表现为DSVR小于乙组(p＝0.0094)；而冠脉远端血流频谱舒张期优势的特征两组相似(p>0.05)。充血反应后甲组冠脉远端CFR明显小于乙组(p<0.05)(图1，2)。甲组近端APV显著高于乙组(p＝0.027)，但甲、乙两组冠脉远端基础状态及峰值APV均无显著差异(p>0.05)。冠脉近端和远端血流速度比值的差别也无显著意义(p>0.05)。
图1 示无高血压病患者冠脉 图2 示高血压病患者冠脉血流储备降低时
, 百拇医药
正常血流储备。CFR＝3.5 的多普勒血流频谱。CFR＝1.7
为了进一步评价甲组血流储备,以CFR>2.0为标准判断CFR正常,发现36支冠脉(84%)CFR正常,7支冠脉(16%)CFR异常。与CFR正常组相比,CFR异常组基础APV较大(25.27±9.79cm/s比18.80±7.20cm/s，p＝0.046),充血反应时APV无显著差别(42.53±16.99cm/s比48.77±13.38cm/s，p＝0.286),而P/DVR和DSVR未见有意义的改变(p>0.05)。
附表 甲、乙两组冠脉流速和血流储备比较 参 数
甲组(n＝43)
乙组(对照，n＝19)
p值
, http://www.100md.com 近端 APV(cm/s)
DSVR
远端 APVb(cm/s)
APVp(cm/s)
DSVRb
DSVRp
CFR
P/DVR
20.53±6.37
1.05±0.33
19.83±7.91
, http://www.100md.com
47.78±14.16
1.29±0.55
1.26±0.52
2.61±0.68
1.16±0.33
16.59±4.58
1.44±0.72
16.03±6.25
46.63±13.42
1.50±0.97
1.19±0.40
, http://www.100md.com 3.09±0.68
1.16±0.40
0.027
0.0094
NS
NS
NS
NS
0.012
NS
注：下标b表示基础状态，下标p表示充血反应时
讨 论
正常冠脉在罂粟碱、潘生丁等血管扩张剂作用下血流量可增加三倍以上，而狭窄冠脉用药后血流不能如此大幅度增加，表现为CFR下降。研究表明CFR还与影响冠脉微循环的因素(如高血压，糖尿病，心肌梗塞，肥厚型心肌病，X综合征等)有关。微循环障碍者尽管造影显示心外膜冠脉并不狭窄，也可出现CFR下降，进而发生劳力性心绞痛或心肌缺血。冠脉微血管病变尚可和严重的心外膜冠脉狭窄同时存在，这种情况下，微血管病变引起的心绞痛只有在心外膜冠脉的成功治疗后才表现出来〔6〕。
, http://www.100md.com
本研究表明，在高血压病患者尽管冠脉造影正常，仍有16%的冠脉CFR异常。其冠脉CFR显著低于无高血压病等循环病变基础者，支持高血压病可引起冠脉CFR降低的观点。据此，临床可应用CFR来评价冠脉微循环的功能。对有劳力性胸痛而冠脉造影正常或轻微狭窄的高血压患者，应测定冠脉CFR以排除冠脉微血管病变引起的胸痛〔1〕。
但在应用CFR作临床评价时应注意到:CFR受测定时血液动力学因素〔1，7〕(前负荷、心率、心肌收缩力)和血液流变学状态(如贫血和血粘度改变)〔1，8，9〕的影响,心动过速和前负荷增加会导致CFR减小〔10〕。为使CFR有最大的可比性,White等认为应在心房起搏100次/分时测定〔1〕。
Mancini等〔11〕则提出用瞬时最大充血反应舒张期流速-主动脉压力关系的斜率(IHDVPS)来反映冠脉狭窄程度。由于我们尚处于应用冠脉内多普勒技术测定CFR的初期，本研究未涉及血液动力学因素和血液流变学状态对CFR结果的影响或IHDVPS测定，这将成为我们今后的研究课题。
, 百拇医药
多普勒血流速度描记钢丝极细，不影响冠脉血流；且易弯曲，不损伤冠脉内膜，不会导致斑块脱落。大量动物和临床研究均表明这一流速测定方法的安全性〔12，13〕，本次研究结果也证明了这一点。
本项目获得上海市医学领先专业重点学科科研基金资助(94-Ⅲ-001)
参考文献
[1]White CW.Clinical applications of Doppler coronary flow reserve measurements.Am J Cardiol,1993,May 71:10D-16D
[2]Di Mario C.Intracoronary Doppler:Instrumentation and principles of analysis and interpretation.Textbook of Interventional Cardiology.Second Edition,Saunders W.C,1993
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[3]Ofili EO,Labovitz AJ and Kern MJ.Coronary flow velocity dynamics in normal and diseased arteries.Am J Cardiol,1993,71:3D-9D
[4]Ofili EO,Kern MJ,Labovitz AJ,et al.Analysis of coronary blood flow velocity dynamics in angiographically normal and stenosed arteries before and after endolumen enlargement by angioplasty.J Am Coll Cardiol,1993,21(2):308～316
[5]Kern MJ,Tron C,Donohue TJ,et al.Hemodynamic significance of coronary jet velocity in patients:Limitations of the Bernouilli equation in small conduits.Am Heart J,1995,129(5):887～894
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[6]Henry T,Laxson DL,McGinn AL,et al.Chest pain after succesful angioplasty:Evidence of microvascular dysfunction.J Am Coll Cardiol,1992,19:384A
[7]Donohue TJ,Kern MJ,Aguirre FV,et al.Assessing the hemodynamic significance of coronary artery stenoses:Analysis of translesional pressre-flow velocity relations in patients.J Am Coll Cardiol,1993,22(2):449～458
[8]Drexler H,Fischell TA,Pinto FJ,et al.Effect of L-arginine on coronary endothelial function in cardiac transplant recipients.Relation to vessel wall morphology.Circulation,1994,89(4):1615～1623
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[9]Fukuda H,Yoshikawa J,Yoshida K,et al.Relationship between regional flow reserve supplied by the greast saphenous vein graft and regional left ventricular wall motion:A Doppler guide wire study.J Cardiol,1995,25(2):83～88
[10]McGinn A,White CW and Wilson RF.Interstudy variability of coronary flow reserve:Influence of heart rate,arterial pressure and ventricular preload.Circulation,1990,81:1319～1330
[11]Mancini GBJ,McGillem MJ,DeBoe SF,et al.The diastolic hyperemic flow versus pressure relation:A new index of coronary stenosis severity and flow reserve.Circulation,1989,80:941～950
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[12]Kern MJ,Donohue TJ,Aguirre FV,et al.Clinical outcome of deferring angioplasty in patients with normal translesional pressure-flow velocity measurements.J Am Coll Cardiol,1995,25(1):178～187
[13]Mechem CJ,Kern MJ,Aguirre FV,et al.Safety and outcome of angioplasty guidewire Doppler instrumentation in patients with normal or mildly diseased coronary arteries.Circulation,1992,86:I～323
(1998-07-20收稿), http://www.100md.com
单位：200032 上海医科大学中山医院，上海市心血管病研究所
关键词：冠脉内多普勒血流速度描记；冠脉血流储备；高血压病
中国超声医学杂志990112
摘 要 目的：探讨冠脉内多普勒血流速度描记评价高血压病患者冠脉微循环功能的价值。方法：我们对26例行冠脉造影的患者进行研究,男17例，女9例，年龄55.08±9.37岁,其中18例为高血压病患者(合并糖尿病2例，合并冠心病2例)。将高血压病患者中冠脉造影正常的43支冠脉列为甲组,包括前降支16支,回旋支13支,右冠脉14支。另8例无高血压病等冠脉微血管病变基础者,共19支冠脉为乙组(对照组),包括前降支8支,回旋支3支,右冠脉8支。用Cardiometrics Flomap II和0.014英寸多普勒钢丝测量：近端及远端平均峰速(APV)、舒张期与收缩期流速比(DSVR)、血流储备(CFR)和近端与远端流速比(P/DVR)。结果:甲组冠脉远端CFR明显较乙组小(2.61±0.68比3.09±0.68，p＝0.012),冠脉近端甲组血流频谱舒张期优势的特征不如乙组明显,表现为DSVR小于乙组(1.05±0.33比1.44±0.72，p＝0.0094)；而冠脉远端血流频谱舒张期优势的特征两组相似(p>0.05)。甲组近端APV显著高于乙组(p＝0.027),但甲、乙两组冠脉远端基础状态及峰值APV均无显著差异(p>0.05)。冠脉近端和远端血流速度比值的差别也无显著意义(p>0.05)。为了进一步评价甲组血流储备,以CFR>2.0为标准判断CFR正常,发现36支冠脉(84%)CFR正常,7支冠脉(16%)CFR异常。与CFR正常组相比,CFR异常组基础APV较大(25.27±9.79cm/s比18.80±7.20cm/s,p＝0.046),充血反应时APV无显著差别(42.53±16.99cm/s比48.77±13.38cm/s，p＝0.286),而P/DVR和DSVR未见有意义的改变(p>0.05)。结论：高血压病患者冠脉血管造影正常者中仍有16%的冠脉血流储备异常。
, 百拇医药
Evaluation of Coronary Microcirculation Function by Intracoronary
Doppler Flowire in Patients with Hypertension
Shao Zhili,Shen Xuedong,Wei Meng,et al
Shanghai Institute of Cardiovascular Diseases,Zhongshan Hospital,Shanghai Medical University,Shanghai 200032
ABSTRACT Objective:To evaluate the coronary microcirculation function in patients with hypertension.Method:coronary flow reserve(CFR)were measured in 26 patients with angiography(17 male,9 female,mean ages 55.08±9.37 years)by Cardiometrics Flomap Ⅱ Ultrasound Instrument and 0.014 inch flowire.The patients were divided into two groups:Group A consisted of 18 hypertensive patients(2 combined with diabetes,2 combined with coronary heart disease),43 arteries with normal angiography were studied by Doppler flowire,including LAD 16 arteries,LCX 13 arteries and RCA 14 arteries.Group B consisted of 8 patients without underlying diseases of coronary microvascular lesions,19 arteries were studied by Doppler flowire,including LAD 8 arteries,LCX 3 arteries and RCA 8 arteries.The proximal and distal average peak velocity(APV),diastolic/systolic velocity ratio(DSVR),coronary flow reserve(CFR)and proximal/distal velocity ratio(P/DVR)were measured.Results:CFR in group A was significantly lower than group B(2.61±0.68 versus 3.09±0.68，p＝0.012).DSVR at proximal coronary artery in group A was less than group B(1.05±0.33 versus 1.44±0.72，p＝0.0094)，which means that the superiority feature of flow pattern in diastole in group A was less than group B.However,at distal coronary artery,the superiority feature of flow pattern in diastole in group A was as the same as group B(p>0.05).APV at the proximal coronary artery in group A was much higher than group B (p＝0.027).To further evaluate CFR in group A,CFR>2.0 was determined as normal CFR criteria according to group B.36 arteries(84%)had normal CFR,and 7 arteries(16%)had abnormal.Comparing with normal CFR group,the baseline APV in abnormal CFR group was higher(25.27±9.79vs.18.80±7.20,p＝0.046)and hyperemic APV was not significantly lower(42.53±16.99vs.48.77±13.38,p＝0.286).P/DVR and DSVR had no significant changes(p>0.05).Conclusion:Although the coronary angiography might be normal in the patients with hypertension,16% arteries had abnormal CFR.
, 百拇医药
KEY WORDS Intracoronary Doppler flowire Hypertension Coronary flow reserve
多普勒血流速度描记评价冠状动脉(冠脉)生理功能是安全可靠的方法〔1〕。该技术不仅可用于测定血流速度还能用于测定冠脉血流储备(CFR)。在无冠脉狭窄的情况下，CFR可反映冠脉的微血管功能。本研究旨在评价多普勒血流速度描记在高血压病患者冠脉微血管功能的应用价值。
资料与方法
研究对象 为26例冠脉造影正常或部分正常的患者，男17例，女9例，年龄55.08±9.37岁。其中18例为高血压病患者(合并糖尿病2例，合并冠心病2例)。将冠脉造影正常的43支冠脉列为甲组，包括前降支16支，回旋支13支，右冠脉14支。另有8例无高血压病等冠脉微血管病变基础者，共19支冠脉被列为乙组(对照组)，包括前降支8支，回旋支3支，右冠脉8支。
, http://www.100md.com
仪器 采用美国Cardiometrics FloMap Ⅱ超声诊断仪和直径0.014英寸(0.036cm)或0.018英寸(0.046cm)易弯曲血流速度描记钢丝。该网丝长175cm，频率12MHz或15MHz，声束扩散角14°，取样容积距换能器5.2mm，纵向直径0.65mm，横向直径约2.25mm。来自冠脉的回声信号经快速富利叶转换，以连续的流速频谱显示(包括流速趋势显示)，并可记录和打印〔2〕。
操作 多普勒血流速度测定均在冠脉造影后进行，经Jodkins大腔导管送入多普勒钢丝至冠脉近端和远端，分别记录冠脉近端和远端的平均峰值流速(APV)，仪器可自动得出舒张期与收缩期冠脉流速比(DSVR)，近端与远端血流血速度之比(P/DVR)。最后将多普勒钢丝留置于冠脉远端，冠脉内注入12mg罂粟碱，测定充血反应达到峰值时APV。峰值与基础APV之比即为冠脉血流储备(CFR)〔2～5〕。
结 果
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本组31例冠脉造影者均获得满意的冠脉内血流速度测定，无一例发生与血流速度测定有关的心律失常、冠脉痉挛、栓塞或穿孔等并发症。甲、乙两组的流速指标见附表。
如表所示,冠脉近端甲组血流频谱舒张期优势的特征不如乙组明显,表现为DSVR小于乙组(p＝0.0094)；而冠脉远端血流频谱舒张期优势的特征两组相似(p>0.05)。充血反应后甲组冠脉远端CFR明显小于乙组(p<0.05)(图1，2)。甲组近端APV显著高于乙组(p＝0.027)，但甲、乙两组冠脉远端基础状态及峰值APV均无显著差异(p>0.05)。冠脉近端和远端血流速度比值的差别也无显著意义(p>0.05)。
图1 示无高血压病患者冠脉 图2 示高血压病患者冠脉血流储备降低时
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正常血流储备。CFR＝3.5 的多普勒血流频谱。CFR＝1.7
为了进一步评价甲组血流储备,以CFR>2.0为标准判断CFR正常,发现36支冠脉(84%)CFR正常,7支冠脉(16%)CFR异常。与CFR正常组相比,CFR异常组基础APV较大(25.27±9.79cm/s比18.80±7.20cm/s，p＝0.046),充血反应时APV无显著差别(42.53±16.99cm/s比48.77±13.38cm/s，p＝0.286),而P/DVR和DSVR未见有意义的改变(p>0.05)。
附表 甲、乙两组冠脉流速和血流储备比较 参 数
甲组(n＝43)
乙组(对照，n＝19)
p值
, http://www.100md.com 近端 APV(cm/s)
DSVR
远端 APVb(cm/s)
APVp(cm/s)
DSVRb
DSVRp
CFR
P/DVR
20.53±6.37
1.05±0.33
19.83±7.91
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47.78±14.16
1.29±0.55
1.26±0.52
2.61±0.68
1.16±0.33
16.59±4.58
1.44±0.72
16.03±6.25
46.63±13.42
1.50±0.97
1.19±0.40
, http://www.100md.com 3.09±0.68
1.16±0.40
0.027
0.0094
NS
NS
NS
NS
0.012
NS
注：下标b表示基础状态，下标p表示充血反应时
讨 论
正常冠脉在罂粟碱、潘生丁等血管扩张剂作用下血流量可增加三倍以上，而狭窄冠脉用药后血流不能如此大幅度增加，表现为CFR下降。研究表明CFR还与影响冠脉微循环的因素(如高血压，糖尿病，心肌梗塞，肥厚型心肌病，X综合征等)有关。微循环障碍者尽管造影显示心外膜冠脉并不狭窄，也可出现CFR下降，进而发生劳力性心绞痛或心肌缺血。冠脉微血管病变尚可和严重的心外膜冠脉狭窄同时存在，这种情况下，微血管病变引起的心绞痛只有在心外膜冠脉的成功治疗后才表现出来〔6〕。
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本研究表明，在高血压病患者尽管冠脉造影正常，仍有16%的冠脉CFR异常。其冠脉CFR显著低于无高血压病等循环病变基础者，支持高血压病可引起冠脉CFR降低的观点。据此，临床可应用CFR来评价冠脉微循环的功能。对有劳力性胸痛而冠脉造影正常或轻微狭窄的高血压患者，应测定冠脉CFR以排除冠脉微血管病变引起的胸痛〔1〕。
但在应用CFR作临床评价时应注意到:CFR受测定时血液动力学因素〔1，7〕(前负荷、心率、心肌收缩力)和血液流变学状态(如贫血和血粘度改变)〔1，8，9〕的影响,心动过速和前负荷增加会导致CFR减小〔10〕。为使CFR有最大的可比性,White等认为应在心房起搏100次/分时测定〔1〕。
Mancini等〔11〕则提出用瞬时最大充血反应舒张期流速-主动脉压力关系的斜率(IHDVPS)来反映冠脉狭窄程度。由于我们尚处于应用冠脉内多普勒技术测定CFR的初期，本研究未涉及血液动力学因素和血液流变学状态对CFR结果的影响或IHDVPS测定，这将成为我们今后的研究课题。
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多普勒血流速度描记钢丝极细，不影响冠脉血流；且易弯曲，不损伤冠脉内膜，不会导致斑块脱落。大量动物和临床研究均表明这一流速测定方法的安全性〔12，13〕，本次研究结果也证明了这一点。
本项目获得上海市医学领先专业重点学科科研基金资助(94-Ⅲ-001)
参考文献
[1]White CW.Clinical applications of Doppler coronary flow reserve measurements.Am J Cardiol,1993,May 71:10D-16D
[2]Di Mario C.Intracoronary Doppler:Instrumentation and principles of analysis and interpretation.Textbook of Interventional Cardiology.Second Edition,Saunders W.C,1993
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[3]Ofili EO,Labovitz AJ and Kern MJ.Coronary flow velocity dynamics in normal and diseased arteries.Am J Cardiol,1993,71:3D-9D
[4]Ofili EO,Kern MJ,Labovitz AJ,et al.Analysis of coronary blood flow velocity dynamics in angiographically normal and stenosed arteries before and after endolumen enlargement by angioplasty.J Am Coll Cardiol,1993,21(2):308～316
[5]Kern MJ,Tron C,Donohue TJ,et al.Hemodynamic significance of coronary jet velocity in patients:Limitations of the Bernouilli equation in small conduits.Am Heart J,1995,129(5):887～894
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[6]Henry T,Laxson DL,McGinn AL,et al.Chest pain after succesful angioplasty:Evidence of microvascular dysfunction.J Am Coll Cardiol,1992,19:384A
[7]Donohue TJ,Kern MJ,Aguirre FV,et al.Assessing the hemodynamic significance of coronary artery stenoses:Analysis of translesional pressre-flow velocity relations in patients.J Am Coll Cardiol,1993,22(2):449～458
[8]Drexler H,Fischell TA,Pinto FJ,et al.Effect of L-arginine on coronary endothelial function in cardiac transplant recipients.Relation to vessel wall morphology.Circulation,1994,89(4):1615～1623
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[9]Fukuda H,Yoshikawa J,Yoshida K,et al.Relationship between regional flow reserve supplied by the greast saphenous vein graft and regional left ventricular wall motion:A Doppler guide wire study.J Cardiol,1995,25(2):83～88
[10]McGinn A,White CW and Wilson RF.Interstudy variability of coronary flow reserve:Influence of heart rate,arterial pressure and ventricular preload.Circulation,1990,81:1319～1330
[11]Mancini GBJ,McGillem MJ,DeBoe SF,et al.The diastolic hyperemic flow versus pressure relation:A new index of coronary stenosis severity and flow reserve.Circulation,1989,80:941～950
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[12]Kern MJ,Donohue TJ,Aguirre FV,et al.Clinical outcome of deferring angioplasty in patients with normal translesional pressure-flow velocity measurements.J Am Coll Cardiol,1995,25(1):178～187
[13]Mechem CJ,Kern MJ,Aguirre FV,et al.Safety and outcome of angioplasty guidewire Doppler instrumentation in patients with normal or mildly diseased coronary arteries.Circulation,1992,86:I～323
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