摘要目的 探讨经胸多普勒超声心动图(TTDE)结合三磷酸腺苷(ATP)负荷试验测定冠状动脉血流储备(CFR)对诊断冠状动脉狭窄的价值.方法 2011年6月至2012年3月,在北京大学第三医院125例因胸痛拟行冠状动脉造影(CAG)的患者,在CAG术前2d内行TTDE-ATP负荷试验检测左前降支(LAD)的CFR,CFR为给予ATP后最大充血状态下LAD舒张期血流速度(PDV2)与静息状态舒张期血流速度(PDV1)之比.采用ROC曲线分析ATP负荷试验测定CFR诊断LAD狭窄的价值.结果 CAG显示LAD狭窄＜50％(A组)57例、LAD狭窄50％ ～ 75％(B组)20例,LAD狭窄＞75％(C组)48例.A组CFR为3.02±0.85,B组CFR为2.49 ±0.65,C组CFR为1.82 ±0.56(P＜0.01).CFR预测LAD狭窄＞50％和＞75％的ROC曲线下面积分别为0.81 (95％ CI0.74 ～0.89,P＜0.01)和0.86(95％ CI0.80 ～0.93,P＜0.01).以CFR＜2.2为截点,诊断LAD狭窄＞50％的敏感度为59％,特异度为82％；诊断LAD狭窄＞75％的敏感度为81％,特异度为83％.结论 经胸多普勒超声心动图结合ATP负荷试验检测CFR对预测冠状动脉显著狭窄有较好的价值,并具有安全易行、费用低廉的优点.

abstractsObjective To assess the diagnostic accuracy of coronary flow reserve measured by transthoracic Doppler echocardiography (TTDE) associated with adenosine triphosphate (ATP) stress for detecting coronary stenosis in patients with chest pain.Methods A total of 125 patients scheduled for elective coronary angiography (CAG) due to chest pain were recruited.ATP stress echocardiography were performed to measure CFR in left anterior descending (LAD) by TTDE with 2 days pre-CAG.Coronary flow reserve (CFR) was calculated as peak diastolic velocity during maximum hyperemia (PDV2) divided by baseline (PDV1).According to the coronary angiography results,all patients were divided into group A (stenosis ＜50％ in LAD,n =57),group B (stenosis of 50％-75％ in LAD,n=20) and group C (stenosis ＞ 75 ％ in LAD,n =48).Then CFR was compared among three groups.The receiver operating characteristic curve (ROC) was used to assess the value of CFR for detecting LAD stenosis.Results CFR was significantly different among three groups (group A:3.02 ± 0.85,group B:2.49 ± 0.65,group C:1.82 ±0.56; all P ＜0.01).With ROC analysis,CFR ＜ 2.2 was the best cut-off value for diagnosing significant LAD stenosis (area under curve:0.86 (95％ CI 0.80 to 0.93)),with sensitivity of 81％,specificity of 83％ and accuracy of 82％ ; CFR ＜ 2.2 for diagnosing LAD stenosis ＞ 50％ (area under curve:0.81(95％ CI 0.74-0.89,P ＜ 0.01)),with a sensitivity of 59％,a specificity of 82％ and an accuracy of 70％.Conclusions CFR measured by TTDE associated with ATP stress is a valuable tool for screening significant stenosis in patients with chest pain.Its advantages are non-invasiveness,easy availability,safety and inexpensiveness.