Direct volumetric blood flow measurement in coronary arteries by thermodilution
Direct volumetric blood flow measurement in coronary arteries by thermodilution
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DOI：
10.1016/j.jacc.2007.08.047
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发表时间：
2007-12-11
影响因子：
24
通讯作者：
van de Vosse, Frans
中科院分区：
文献类型：
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作者：
Aarnoudse, Wilbert;van't Veer, Marcel;van de Vosse, Frans
目的本研究旨在验证一种在动物和有意识的人心导管术中直接测量冠状动脉容量血流的新方法。背景直接测量特定冠状动脉的血流量对研究冠状动脉循环是有用的。方法基于室温下连续低速率滴注生理盐水的热稀释原理，设计了心导管置管过程中直接流量测量的仪器装置。使用2.8 f输注导管和标准的0.014英寸传感器尖端压力/温度导丝，根据生理盐水的输注速率、输注导管尖端生理盐水的温度和输注过程中远端血液温度计算冠状动脉绝对流量（Q(thermo)）。该方法在5只长期使用仪器的狗和35名接受冠状动脉狭窄生理评估或经皮冠状动脉介入治疗的患者中进行了大范围的流量测试。结果所有犬的热调节流量与真流量(Q)吻合良好(Q(thermo) = 0.73 Q + 42 ml/min；R-2 = 0.72)。重现性极好(Q（热）= 0.96 × Q（热，2）+ 3 ml/min；R-2 = 0.89)。测量结果与理论预测的输液速率和传感器位置无关。在人类中，经皮冠状动脉介入治疗后热调节衍生的容量血流量增加与血流储备分数增加之间存在良好的一致性（R-2 = 0.84）；测量结果重现性好(Q(thermo,1) = 1-0 Q(thermo,2) + 0.9 ml/min, R-2 = 0.97)，且测量结果与输液速率和传感器位置无关。结论采用合适的输液管和0.014英寸传感器尖端导丝测量冠状动脉压力和温度，可在心导管置入术中直接测量特定冠状动脉的容量血流量。
Objectives This study sought to validate a new method for direct volumetric blood flow measurement in coronary arteries in animals and in conscious humans during cardiac catheterization.Background Direct volumetric measurement of blood flow in selective coronary arteries would be useful for studying the coronary circulation.Methods Based on the principle of thermodilution with continuous low-rate infusion of saline at room temperature, we designed an instrumental setup for direct flow measurement during cardiac catheterization. A 2.8-F infusion catheter and a standard 0.014-inch sensor-tipped pressure/temperature guidewire were used to calculate absolute flow (Q(thermo)) in a coronary artery from the infusion rate of saline, temperature of the saline at the tip of the infusion catheter, and distal blood temperature during infusion. The method was tested over a wide range of flow rates in 5 chronically instrumented dogs and in 35 patients referred for physiological assessment of a coronary stenosis or for percutaneous coronary intervention.Results Thermodilution-derived flow corresponded well with true flow (Q) in all dogs (Q(thermo) = 0.73 Q + 42 ml/min; R-2 = 0.72). Reproducibility was excellent (Q(thermo) = 0.96 X Q(thermo,2) + 3 ml/min; R-2 = 0.89). The measurements were independent of infusion rate and sensor position as predicted by theory. In the humans, a good agreement was found between increase of thermodilution-derived volumetric blood flow after percutaneous coronary intervention and increase of fractional flow reserve (R-2 = 0.84); reproducibility of the measurements was excellent (Q(thermo,1) = 1-0 Q(thermo,2) + 0.9 ml/min, R-2 = 0.97), and the measurements were independent of infusion rate and sensor position.Conclusions Using a suitable infusion catheter and a 0.014-inch sensor-tipped guidewire for measurement of coronary pressure and temperature, volumetric blood flow can be directly measured in selective coronary arteries during cardiac catheterization.