Assessing coronary stenosis severity--a recurrent clinical need.
Assessing coronary stenosis severity--a recurrent clinical need.
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评估冠状动脉狭窄的严重程度——经常出现的临床需求。
DOI：
10.1016/s0735-1097(86)80096-1
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发表时间：
1986
影响因子：
24
通讯作者：
K. Gould
中科院分区：
文献类型：
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作者：
K. Gould
Picano et al. (I)在这期杂志中，有一个有趣的观察，即在冠状动脉严重狭窄的情况下，药物性冠状动脉血管扩张会使局部左心室功能短暂受损。作者认为，超声心动图监测静脉注射潘生丁后的左心室功能是一个很好的指标，冠状动脉狭窄的严重程度。为了正确地解释他们的发现，对这个问题做一个简要的概述是合适的。评估冠状动脉狭窄严重程度的方法。客观地量化冠状动脉狭窄的严重程度在临床心脏病学中变得越来越重要，原因有很多。定量测量是必要的：1）用于评估干预治疗，如胆固醇控制，压力管理，药理学药物，经皮腔内冠状动脉成形术和急性心肌梗死溶栓，2）用于与非侵入性诊断技术进行比较，3）用于理解流体动力学在动脉粥样硬化形成中的关键作用，以及4）越来越多，用于常规临床决策，包括冠状动脉疾病的药物与机械治疗。描述狭窄严重程度有两种根本不同的方法（2）。解剖学-几何学方法利用了狭窄的所有X射线确定的几何尺寸，包括狭窄百分比、绝对直径和长度效应。使用流体动力学方程在狭窄的整个长度上对这些尺寸进行积分，以预测狭窄（3-5）或冠状动脉血流储备（6，7）的压力流动特性。通常仅使用狭窄百分比或绝对直径，但每一种都是描述严重程度的正确解剖-几何方法的不完全近似值（2，4，6-9）。部分原因是这些部分几何的失败
The study by Picano et al.(I) in this issue of the Journal makes an interesting observation, that is, that regional left ventricular function is transiently impaired during pharmacologic coronary arteriolar vasodilation in the presence of severe coronary artery stenosis. The authors suggest that echocardiographic monitoring of left ventricular function after intravenous dipyridamole is a good index of severity of coronary artery stenoses. To interpret their findings in perspective, a brief overview of the problem is appropriate. Approaches to assessing coronary stenosis severity. Quantifying the severity of coronary artery stenosis objectively is becoming increasingly important in clinical cardiology for many reasons. Quantitative measurements are necessary I) for evaluating intervention therapy such as cholesterolcontrol, stress management, pharmacologicagents, percutaneous transluminal coronary angioplasty and thrombolysis in acute myocardial infarction, 2) for comparison with noninvasive diagnostic techniques, 3) for understanding the critical role of fluid dynamics in atherogenesis, and 4) increasingly, for routine clinical decisions involving medical versus mechanical treatment of coronary artery disease. There are two fundamentally different approaches for describing stenosis severity (2). The anatomic-geometric approach utilizes all of the X-ray-determined geometric dimensions of a stenosis, including percent narrowing, absolute diameter and length effects. These dimensions are integrated throughout the length of the stenosis using fluid dynamic equations to predict the pressure flow characteristics of the stenosis (3-5) or coronary flow reserve (6, 7). Percent narrowing or absolute diameter alone is commonly used, but each is an incomplete approximation of the correct anatomic-geometric method for describing severity (2, 4, 6-9). In part because of the failure of these partial geometric