摘要
目的 利用数字减影血管造影(DSA)和冠状动脉(冠脉)CT血管成像(CTA)评估不稳定型心绞痛(UAP)患者经皮冠脉介入治疗(PCI)后对冠脉内血流动力学的影响.方法 选择2018年7月至2019年7月于河北北方学院附属第一医院心内科确诊的50例UAP患者为研究对象.所有患者均接受择期PCI治疗,采用CTA结合计算流体力学(CFD)方法定量计算治疗前和治疗后靶病变处血流动力学指标包括管壁压力、压力阶差、最大血流速度、最大管壁切应力(WSS)、血流储备分数(FFR),用DSA评价支架置入即刻前向血流TIMI分级.结果 50例患者靶血管位于前降支26例(52.0%),回旋支8例(16.0%),右冠16例(32.0%).治疗前,CTA测量靶病变处最小管腔直径1.1~1.9 mm,平均(1.4±0.3)mm;最小管腔面积2.1~2.8 mm2,平均(2.5±0.3)mm2;斑块长度8.5~16.5 mm,平均(12.6±4.1)mm;狭窄程度75%~90%,平均(83.5±7.2)%.治疗后最小管腔直径和最小管腔面积均明显增大(P<0.05),残余狭窄5%~25%,平均(13.6±5.5)%.治疗前CTA测量靶病变处管壁压力40~75 mmHg,平均(61.2±10.3)mmHg;压力阶差15~45 mmHg,平均(28.9±9.6)mmHg;最大血流速度0.8~1.7 m/s,平均(1.3±0.3)m/s;最大WSS=8.5~18.6 Pa,平均(13.3±4.5)Pa;FFR=0.55~0.79,平均(0.63±0.12).治疗后管壁压力和FFR均明显升高(P<0.05),而压力阶差、最大血流速度、最大WSS均明显降低(P<0.05).50例支架置入即刻TIMI分级2级10例,3级40例.结论 CTA结合CFD以及DSA是评估UAP冠脉内血流动力学变化的重要方法,CTA结合CFD可提供冠脉狭窄和粥样斑块的解剖学和功能学信息,为个性化制定治疗策略和评估PCI疗效有较好的应用价值.
Objective To review the influence of percutaneous coronary intervention(PCI)on intracoronary hemodynamics in patients with unstable angina pectoris(UAP)by applying digital subtraction angiography(DSA)and coronary CT angiography(CTA).Methods UAP patients(n=50)were chosen from Department of Cardiology in the First Affiliated Hospital of Hebei North University from July 2018 to July 2019.All patients were received selected PCI.The hemodynamic indexes in target lesions including wall pressure,pressure gradient,the maximum blood flow velocity,the maximum wall shear stress(WSS)and fractional flow reserve(FFR)were calculated by applying CTA and computational fluid dynamics(CFD)before and after PCI.The TIMI classification of immediate forward flow of stent implantation was reviewed by using DSA.Results Among 50 patients,26 patients(52.0%)had target vessels in anterior descending branch,8 patients(16.0%),in circumflex branch and 16 patients(32.0%),in right coronary artery.Before treatment,CTA detection results showed that the minimal lumen diameter(MLD)was from 1.1 mm to 1.9 mm and mean MLD was(1.4±0.3)mm,and the minimal lumen area(MLA)was from 2.1~2.8 mm2 and mean MLA was(2.5±0.3)mm2,the length of plaques was from 8.5 mm to 16.5 mm and mean length was(12.6±4.1)mm,and severity of stenosis was from 75~90%and mean value was(83.5±7.2)%in target lesions.After treatment,MLD and MLA increased significantly(P<0.05),residual stenosis was from 5%to 25%and mean residual stenosis was(13.6±5.5)%.Before treatment,CTA detection results showed that wall pressure was from 40 mmHg to 75 mmHg and mean value was(61.2±10.3)mmHg,pressure gradient was from 15 mmHg to 45 mmHg and mean value was(28.9±9.6)mmHg,the maximum blood flow velocity was from 0.8 m/s to 1.7 m/s and mean value was(1.3±0.3)m/s,the maximum WSS was from 8.5 Pa to 18.6 Pa and mean value was(13.3±4.5)Pa,and FFR was from 0.55 to 0.79 and mean value was(0.63±0.12).After treatment,wall pressure and FFR increased significantly(P<0.05),and pressure gradient,the maximum blood flow velocity and the maximum WSS decreased significantly(P<0.05).Among 50 cases,there were 10 cases of grade 2 immediate TIMI classification of stent implantation and 40 cases of grade 3 immediate TIMI classification of stent implantation.Conclusion CTA combined with CFD and DSA is an important method for reviewing the changes of intracoronary hemodynamics of UAP.CTA combined with CFD can provide anatomical and functional information of coronary stenosis and atherosclerotic plaques,which has a good value for personalized treatment strategy and evaluation of PCI efficacy.
作者
秦少强
梁惠清
王晓元
张占帅
李会贤
张鹏祥
王蕊
李方江
Qin Shaoqiang;Liang Huiqing;Wang Xiaoyuan;Zhang Zhanshuai;Li Huixian;Zhang Pengxiang;Wang Rui;Li Fangjiang(Department of Cardiology,First Affiliated Hospital of Hebei North University,Zhangjiakou 075000,China.)
出处
《中国循证心血管医学杂志》
2020年第6期687-689,693,共4页
Chinese Journal of Evidence-Based Cardiovascular Medicine
基金
河北省张家口市2016年度科技计划自筹经费项目(1621079D)。
关键词
不稳定型心绞痛
经皮冠状动脉介入
血流动力学
计算流体力学
Unstable angina pectoris
Percutaneous coronary intervention
Hemodynamics
Computational fluid dynamics
