Assessment of coronary microcirculation in a swine animal model.
Assessment of coronary microcirculation in a swine animal model.
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DOI：
10.1152/ajpheart.00213.2011
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发表时间：
2011-08
期刊：
影响因子：
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通讯作者：
Zhang Zhang-Zhang;Shigeho Takarada;S. Molloi
中科院分区：
文献类型：
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作者：
Zhang Zhang-Zhang;Shigeho Takarada;S. Molloi
冠状动脉微血管功能障碍具有重要的预后意义。采用冠状动脉血流储备（CFR）、微血管阻力和零流压（P（zf））等血流动力学指标，建立评价冠状动脉微循环的最可靠指标。15只猪用流量探针进行器械化，并将压力导丝推进到远端左前降支动脉中。腺苷用于产生最大充血。微球被用于产生微血管功能障碍。使用封堵器造成狭窄。记录探头的血流量（Q（p））、主动脉压、远端冠状动脉压和右心房压。使用时间-密度曲线计算血管造影血流（Q（a））。分别使用Q（p）和Q（a）计算基于流量探头的CFR和血管造影CFR。在充血期间，分别使用Q（p）和Q（a）确定基于流量探针的（NMR（qh））和血管造影标准化微血管阻力（NMR（ah））。使用Q（p）和远端冠状动脉压力计算P（zf）。生成两个系列的受试者工作特征曲线：正常心外膜动脉模型（N模型）和狭窄模型（S模型）。基于流量探头的CFR、血管造影CFR、NMR（qh）、NMR（ah）和P（zf）的受试者工作特征曲线下面积在N模型中分别为0.855、0.836、0.976、0.956和0.855，在S模型中分别为0.737、0.700、0.935、0.889和0.698。NMR（qh）和NMR（ah）检测微血管恶化的可靠性明显高于CFR和P（zf）。与CFR和P（zf）相比，NMR能更准确地评价微循环。当存在狭窄时，这种改善的准确性更普遍。此外，NMR（ah）是一种潜在的微创方法，用于评估冠状动脉微循环。
Coronary microvascular dysfunction has important prognostic implications. Several hemodynamic indexes, such as coronary flow reserve (CFR), microvascular resistance, and zero-flow pressure (P(zf)), were used to establish the most reliable index to assess coronary microcirculation. Fifteen swine were instrumented with a flow probe, and a pressure wire was advanced into the distal left anterior descending artery. Adenosine was used to produce maximum hyperemia. Microspheres were used to create microvascular dysfunction. An occluder was used to produce stenosis. Blood flow from the probe (Q(p)), aortic pressure, distal coronary pressure, and right atrium pressure were recorded. Angiographic flow (Q(a)) was calculated using a time-density curve. Flow probe-based CFR and angiographic CFR were calculated using Q(p) and Q(a), respectively. Flow probe-based (NMR(qh)) and angiographic normalized microvascular resistance (NMR(ah)) were determined using Q(p) and Q(a), respectively, during hyperemia. P(zf) was calculated using Q(p) and distal coronary pressure. Two series of receiver operating characteristic curves were generated: normal epicardial artery model (N model) and stenosis model (S model). The areas under the receiver operating characteristic curves for flow probe-based CFR, angiographic CFR, NMR(qh), NMR(ah), and P(zf) were 0.855, 0.836, 0.976, 0.956, and 0.855 in N model and 0.737, 0.700, 0.935, 0.889, and 0.698 in S model. Both NMR(qh) and NMR(ah) were significantly more reliable than CFR and P(zf) in detecting the microvascular deterioration. Compared with CFR and P(zf), NMR provided a more accurate assessment of microcirculation. This improved accuracy was more prevalent when stenosis existed. Moreover, NMR(ah) is potentially a less invasive method for assessing coronary microcirculation.