kpcczКомплексные проблемы сердечно-сосудистых заболеванийComplex Issues of Cardiovascular Diseases2306-12782587-9537Federal State Budgetary Institution “Research Institute for Complex Issues of Cardiovascular Diseases”10.17802/2306-1278-2016-2-20-29kpccz-186Research ArticleАКТУАЛЬНЫЕ ПРОБЛЕМЫ КАРДИОЛОГИИ И СЕРДЕЧНО-СОСУДИСТОЙ ХИРУРГИИACTUAL PROBLEMS OF CARDIOLOGY AND CARDIOVASCULAR SURGERYДИАГНОСТИКА СТЕНОЗОВ СТВОЛА ЛЕВОЙ КОРОНАРНОЙ АРТЕРИИ И ПЕРЕДНЕЙ НИСХОДЯЩЕЙ КОРОНАРНОЙ АРТЕРИИ С ПОМОЩЬЮ ТРАНСТОРАКАЛЬНОЙ ЭХОКАРДИОГРАФИИEVALUATION OF STENOTIC LEFT main coronary ARTERY AND LEFT ANTERIOR DESCENDING CORONARY ARTERY WITH A HELP OF TRANSTHORACIC ECHOCARDIOGRAPHYБОЩЕНКОА. А.BOSHCHENKOA. A.

Адрес: 634012, г. Томск, ул. Киевская, 111 А Тел. 8 (3822) 55-34-45

bosh@cardio-tomsk.ruВРУБЛЕВСКИЙА. В.VRUBLEVSKYA. V.КАРПОВР. С.KARPOVR. S.Федеральное государственное бюджетное научное учреждение «Научно-исследовательский институт кардиологии». Томск, РоссияРоссияFederal State Budgetary Scientifical Institution Research Institute for Cardiology. Tomsk, RussiaRussian Federation201626062016022029Copyright © БОЩЕНКО А.А., ВРУБЛЕВСКИЙ А.В., КАРПОВ Р.С., 20162016БОЩЕНКО А.А., ВРУБЛЕВСКИЙ А.В., КАРПОВ Р.С.BOSHCHENKO A.A., VRUBLEVSKY A.V., KARPOV R.S.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.nii-kpssz.com/jour/article/view/186Цель

Цель. Оценить возможности неконтрастной трансторакальной эхокардиографии (ТТ ЭхоКГ) для качественной, полуколичественной и количественной диагностики стенозов ствола левой коронарной артерии (ЛКА) и передней нисходящей коронарной артерии (ПНА).

Материалы и методы

Материалы и методы. ТТ ЭхоКГ выполнена у 173 человек (средний возраст 52±10 лет; 149 мужчин) с болью в левой половине грудной клетки, направленных в стационар для проведения коронарной ангиографии (КАГ). Исследован ствол ЛКА, проксимальный (пр/3), средний (ср/3) и дистальный (д/3) сегменты ПНА. Доплерографическими признаками стенозирования >50 % считали: 1 – локальный aliasing при использовании предела Найквиста 60 см/с; 2 – максимальную пиковую диастолическую скорость корнарного кровотока (Vpd) >60 см/с; 3 – отношение стенотическая Vpd / престенотическая Vpd >2,0; 4 – стеноз >50 % в соответствии с уравнением непрерывности потока: стеноз, % = 100 % × (1 – престенотический VTId / стенотический VTId), где VTId – интеграл скорости кровотока в диастолу. КАГ была проведена в течение 1 недели после ТТ ЭхоКГ; стенозы определяли как значимые, если уменьшение диаметра сосуда превышало 50 %.

Результаты

Результаты. Чувствительность (Ч), специфичность (Сп) и диагностическая точность различных доплерографических признаков для выявления стенозов ЛКА и ПНА представлены в таблице 1. Таким образом, ТТ ЭхоКГ является корректным неинвазивным методом диагностики стенозов ЛКА и ПНА. Количественное сравнение скоростей кровотока в престенотическом и стенотическом участках является более чувствительным доплеровским признаком стенозования >50 %, чем качественная и полуколичественная оценка стенозирования по максимальной скорости кровотока.

Purpose

Purpose. To detect the potential of different qualitative, semi-quantitative and quantitative transthoracic Doppler signs for successful evaluation of stenotic left main coronary artery (LMCA) and left anterior descending artery (LAD).

Materials and methods

Materials and methods. 173 patients (52±10 years; 149 men) with chest pain, sinus rhythm and scheduled quantitative coronaryangiography (CAG) were evaluated at rest by non-contrast transthoracic echocardiography (TT E). LMCA and proximal (p), mid (m) and distal (d) parts of the LAD were examined. The Doppler signs of coronary stenosis >50 % were determined as follows: 1 – local Doppler aliasing with the Nyquist limit set at 60 cm/s; 2 – maximal peak diastolic velocity (Vpd) >60 cm/s; 3 – ratio of stenotic/prestenotic Vpd >2.0; 4 – stenosis >50 % according to flow continuous equation: stenosis, % = 100 × (1 – prestenotic VTId / stenotic VTId), where VTId – diastolic time velocity integral. CAG was performed within 1 week after TT E. Stenosis >50 % of diameter reduction was considered as significant.

Results

Results. Sensitivity (Sens), specificity (Sp) and diagnostic accuracy (Ac) of different Doppler stenotic signs for stenotic LMCA andLAD are presented in Table 1. Thus, TT E is a method for correct evaluation of stenotic LMCA and LAD. Quantitative ratio of stenotic to prestenotic coronary flow velocities is a more sensitive sign for detecting stenosis >50 %, than qualitative and semi-quantitative evaluation of maximal coronary flow velocity only.

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The authors declare that there are no conflicts of interest present.