medvisМедицинская визуализацияMedical Visualization1607-07632408-9516RDS-Media Ltd.medvis-197Research ArticleСЕРДЦЕ И СОСУДЫHEART AND VESSELSНеинвазивная оценка кровотока в левой коронарной артерии во время физической нагрузки. Трехлетний прогнозNoninvasive Assessment of Lad Coronary Flow Parameters During Exercise Test. 3-Year PrognosisЗагатинаАнжела ВалентиновнаZagatinaAngela Valentinovnazag_angel@yahoo.comЖуравскаяНадежда ТимофеевнаZhuravskayaNadezhda Timofeevnanoemail@neicon.ruКрыловаЛюдмила ГеннадьевнаKrylovaLyudmila Gennadievnanoemail@neicon.ruКардиоцентр “Медика”РоссияCardiology center “Medika”Russian FederationЛенинградский областной кардиологический диспансерРоссияLeningrad Regional Cardiology DispensaryRussian Federation201528042015024552Copyright © Загатина А.В., Журавская Н.Т., Крылова Л.Г., 20152015Загатина А.В., Журавская Н.Т., Крылова Л.Г.Zagatina A.V., Zhuravskaya N.T., Krylova L.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://medvis.rdsmedia.ru/jour/article/view/197

Неинвазивное исследование кровотока в коронарных артериях с помощью ультразвуковых техник - многообещающая методика для диагностики ишемической болезни сердца. В настоящий момент в международной литературе отсутствуют данные о значимости таких исследований во время тестов с физической нагрузкой. Цель исследования: определение прогностической роли неинвазивно определенного коронарного резерва (КР) во время стресс-эхокардиографии с физической нагрузкой. Материал и методы. В одноцентровое проспективное исследование включено 299 пациентов, направленных на стресс-эхокардиографию с физической нагрузкой. Диастолические скорости кровотока в передней межжелудочковой артерии (ПМЖА) были измерены до и на пике физической нагрузки. Были рассчитаны КР и разница между скоростями на пике и в покое (ΔV). Данные о состоянии здоровья 259 пациентов были доступны через 3 года. Смерть по сердечно-сосудистым причинам, инфаркт миокарда, реваскуляризация миокарда и остановка кровообращения с сердечнолегочной реанимацией были конечными точками исследования. Результаты. 77 пациентов достигли конечных точек. Группа с неблагоприятными исходами по сравнению с группой остальных пациентов имела более низкие значения скоростей в ПМЖА на пике нагрузки (58 ± 30 см/с против 68 ± 26 см/с, p < 0,03), ΔV (18 ± 21 см/с против 35 ± 24 см/с, p < 0,00002) и КР (1,5 ± 0,5 против 2,0 ± 0,7, p < 0,00002). В группе с КР > 2 1% пациентов имели неблагоприятные исходы, тогда как группа с КР ≤ 2 достигала конечных точек в 40% (р < 0,000001). Выводы. Анализ коронарного кровотока в ПМЖА на пике нагрузке может использоваться для определения трехлетнего прогноза.

Assessment of coronary flow is used during pharmacological tests. Nevertheless, supine bicycle tests have allowed the application of coronary flow assessments during exercise. The aim of the study was to define the outcomes of the consecutive cohort in three years period after coronary artery flow velocity analysis during exercise tests. Materials and methods. There is a single center prospective cohort study of 299 patients who underwent a bicycle exercise echocardiography with the analysis of coronary artery flow velocity in left anterior coronary artery (LAD). Coronary flow velocities were measured before and at the peak of exercise at the medium segment of the LAD. In addition, the coronary flow velocity reserve (CFVR) and the differences between the peak and rest velocities (ΔV) were calculated. Two hundred and fifty-nine patients were accessible for follow-up analysis (56 ± 9 years, 167 men). Cardiovascular death, nonfatal myocardial infarction, revascularization or cardiac arrests with cardiopulmonary resuscitation were defined as major adverse cardiac events (MACE). The period after stress test was 3.0 ± 0.1 years. Results. There were 77 patients with MACE. The group with MACE vs the rest patients had a lower velocity in LAD at the peak of exercise (58 ± 30 vs 68 ± 26 cm/s, p < 0.03), ΔV (18 ± 21 vs 35 ± 24 cm/s, p < 0.00002), and CFVR (1.5 ± 0.5 vs 2.0 ± 0.7, p < 0.00002). Among the group with CFVR > 2.1% had myocardial infarction, death or coronary artery bypass grafting in 3-year period. The group with CFVR ≤ 2 had МАСЕ in 40% of cases (p < 0.000001). Conclusion. The analysis of coronary flow in LAD during exercise can be used as a predictor of 3-year outcomes.

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