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Трансторакальное ультразвуковое исследование магнистральных коронарных артерий: методические аспекты, возможности, ограничения

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На основании обследования 81 больного ИБС, направленного для проведения коронарной ангиографии, и 19 здоровых добровольцев без факторов риска ИБС изучены методические аспекты, возможности и ограничения трансторакального ультразвукового исследования магистральных коронарных артерий, проведенного без эхоконтрастирования. Исследованы ствол левой коронарной артерии, проксимальные, средние и дистальные сегменты передней нисходящей, огибающей и правой коронарных артерий. Трансторакальная эхокардиография является адекватным методом визуализации ствола левой коронарной артерии, всех сегментов передней нисходящей артерии и дистального сегмента правой коронарной артерии. Частота успешной трансторакальной визуализации передней нисходящей и правой коронарной артерий не зависит от конституции больного. Параметры ламинарного коронарного кровотока у здоровых добровольцев сопоставимы во всех трех магистральных артериях и достоверно не меняются от проксимальных сегментов к дистальным. Передняя нисходящая артерия может служить моделью для проведения исследований коронарного кровотока у лиц без коронарных стенозов. Трансторакальная эхокардиография является высокоспецифичным методом диагностики стенозов магистральных коронарных артерий, однако может быть рекомендована только для выявления стенозирования ствола левой коронарной артерии и передней нисходящей артерии.

Ключевые слова:
трансторакальная эхокардиография, допплерография, магистральные коронарные артерии, гемодинамически значимый стеноз, скорость кровотока в коронарных артериях

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Transthoracic Echocardiography in the Assessment of Main Coronary Arteries: Methodological Aspects, Potentials, and Limitations

The methodological aspects, potentials, and limitations of transthoracic echocardiography (TTE) without contrast enhancement in the assessment of main coronary arteries (MCA) were established in 81 coronary heart disease (CHD) patients who underwent coronary angiography within 1 week after TTE and in 19 healthy volunteers without risk CHD factors. We searched for the left main coronary artery (LMCA), proximal (p), mid (m) and distal (d) segments of the left anterior descending artery (LAD), the circumflex artery (Cx), and the right coronary artery (RCA). It was determined that TTE is an adequate method for assessment of the LMCA, all LAD segments, and dRCA. It was established that the quality of color Doppler mapping and the frequency of good Doppler velocity pattern detection does not depend on the body build for the LAD and RCA. For the first time, coronary blood flow parameters in healthy volunteers without risk CHD factors were determined. It was detected that normal coronary blood flow parameters are comparable in all three arteries – LAD, Cx and RCA, and do not change from proximal to distal segments. In addition, the LAD may be a model for the coronary blood flow assessment in persons without coronary artery stenosis as this vessel demonstrates a good Doppler flow patterns in all three (proximal, mid and distal) segments. It was established that TTE is a highly specific noninvasive method for identification of MCA stenosis >50%, which may be mainly recommended for the diagnosis of LMCA and LAD stenosis.

Keywords:
transthoracic echocardiography, Doppler, main coronary arteries, significant stenoses, coronary flow velocity