Clinical research of Coronary flow reserve in Kawasaki disease

为探讨川崎病相关冠状动脉病变的病理意义，我们应用多普勒血流导丝对66例有川崎病病史的儿童冠状动脉病变的血流速度模式和血流储备进行了研究。66例选择性冠状动脉造影术检出22例30个瘤样病变和8例8个狭窄病变。冠状动脉血流储备(CFR)以ATP充血所致充血与基线平均峰值血流速度之比计算。在冠状动脉造影正常的冠状动脉中，儿童时期的CFR有如下特征：与LAD和RCA相比，LCA和LCA的CFR显著降低，而LCA的CFR显著低于老年。在扩张型冠状动脉病变中，平均峰值血流速度和舒张期/收缩期血流速度比显著降低，且与病变大小显著相关。在狭窄的冠状动脉病变中，狭窄程度与计算的狭窄程度之间存在显著的相关性(R2=0.92)。在血管造影正常的冠状动脉(6例)，在铊心肌显像上有任何缺血发现，观察到CFR降低。使用Diooler血流导丝评价冠状动脉血流动力学和血流储备对评价川崎病冠状动脉病变的病理意义有临床价值。

To evaluate the pathologic significance of the coronary artery lesions associated with Kawasaki disease, we studied coronary arterial flow velocity patterns and flow reserve in coronary lesions using a doppler flow guidewire in 66 childrens with a history of Kawasaki disease. From Selective coronary angiography in these 66 patients, 30 aneurysmal lesions in 22 patients and 8 stenotic lesions in 8 patients were detected. Coronary flow reserve (CFR) was calculated as a ratio of ATP-induced hyperemic to baseline average peak velocity.In the angiographically normal coronary arteries, there were some characteristic findings in CFR in childhood as follows : CFR was significantly lower in LCX as compared with LAD and RCA and CFRs in LCA were significantly lower in the younger-age group than in the elder. In the dilatative coronary lesions, the significant decrease in average peak velocity and diastoli-to-systolic velocity ratio were observed, and were significantly correlated with the size of the lesions. Reduced CFR was also observed in the dilatated lesions, and was correlated with the size of lesions in frequency.In the stenotic coronary lesions, there was a significant sorrelation between the angiographic stenotic ratio and the calculated stenotic ratio on flow velocity change (r2=0.92). In the angiographically normal coronary arteries (6 patients) with any ischemic findings on thallium myocardial scintigraohy, reduced CFR was observed.Evaluation of coronary flow dynamics and flow reserve using a diooler flow guidewire was clinically useful to assess the pathologic significance of coronary lesions in Kawasaki disease.