水静压对冠状动脉流量的影响和冠状动脉狭窄症严重程度的基于压力指数
Firas Al-Janabi1,2, Grigoris V Karamasis1,2,3, Christopher M Cook1,2
1Essex Cardiothoracic Centre, MSE Foundation Trust, Basildon SS16 5NL, UK.
Journal of clinical medicine
|March 28, 2024
概括
在侵袭性冠状动脉狭窄的评估过程中,患者的位置显著影响了基于压力的指数,如Pd/Pa,即时无波比率 (iFR) 和分数流量储备 (FFR). 这些由水静压变化驱动的变化,可以改变诊断分类,而不会影响冠状动脉流动.
科学领域:
- 心血管生理学心血管生理学
- 干预心脏病学 干预心脏病学
- 诊断成像和测量 诊断成像和测量
背景情况:
- 水静压梯度可能源于患者躺卧和俯卧姿势之间的冠状动脉高度差异.
- 这些压力梯度可能会影响侵入性生理狭窄的评估,影响基于压力的指数和冠状动脉流量.
研究的目的:
- 评估由于患者的位置 (仰卧或俯卧) 而导致的水静压变化对基于冠状动脉压力指数和流量的影响.
- 确定位置变化是否会影响冠状动脉狭窄症的诊断分类.
主要方法:
- 在21名患有稳定冠状动脉疾病的患者中,评估了23例冠状动脉狭窄症.
- 测量Pd/Pa,即时无波比 (iFR),分量流量储备 (FFR) 和冠状动脉流速 (平均峰值速度,APV) 在倾斜的位置进行,然后在仰卧的位置重复测量.
- 患者在之前的冠状动脉血管学上至少有50%的视觉定义狭窄症.
主要成果:
- 在不同冠状动脉 (LAD,Cx,RCA) 的俯卧和仰卧位置之间观察到平均Pd/Pa,iFR和FFR的显著变化.
- 休息和高血压冠状动脉流 (APV) 在位置之间没有显著变化.
- 很大一部分测量被重新分类到缺血值:36%的iFR和26%的FFR在比较倾斜和仰卧姿势时.
结论:
- 由于俯卧或卧卧的位置造成的水静压变化显著影响Pd/Pa,iFR和FFR测量.
- 观察到的变化是以压力为基础的现象,因为冠状动脉流动不受影响.
- 患者的位置是侵入性生理狭窄症评估中需要考虑的关键因素,因为它可以改变诊断解释.
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