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Трансторакальное ультразвуковое исследование резерва коронарного кровотока: патофизиологические, методические и клинические аспекты

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В статье рассмотрены основные методические, патофизиологические и клинические аспекты трансторакального допплерографического исследования резерва коронарного кровотока. Подробно описана методика визуализации магистральных коронарных артерий из трансторакально го доступа, обсуждены возможности, ограничения и ошибки метода. Представлена интерпретация фазовой структуры коронарного кровотока в покое. Обоснован выбор стрессорных агентов и способов расчета при трансторакальном исследовании коронарного резерва. Обсуждены патофизиологические механизмы развития коронарного перфузионного дефицита и снижения коронарного резерва при стенозах магистральных коронарных артерий, определены допплерографические критерии гемодинамически значимого стенозирова ния. Проанализирована роль показателя коронарного резерва в диагностике ишемии, оценке эффективности реваскуляри зационных вмешательств и стратификации прогноза у больных ИБС. Обсуждены основные показания к оценке коронарного резерва в клинической практике.

Ключевые слова:
трансторакальное ультразвуковое исследование (трансторакальная эхокардиография), вторая тканевая гармоника, резерв коронарного кровотока, стеноз коронарной артерии, передняя нисходящая коронарная арте

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Transthoracic Ultrasound Assessment of Coronary Flow Reserve: Pathophysiological, Methodical, and Clinical Aspects

The main methodical, pathophysiological, and clinical aspects of coronary flow reserve assessment at transthoracic echocardiography were described in the article. The methodology of main coronary arteries visualization from transthoracic approach was described in details. The possibilities, restrictions, and mistakes of the method were discussed. The interpretation of coronary blood flow phase structure at rest was introduced. The selection of stress agents and calculation method for transthoracic ultrasound assessment of coronary flow reserve was substantiated. The pathophysiological mechanisms of coronary perfusion deficiency development and decrease of coronary flow reserve due to coronary artery stenosis were discussed. The dopplerography criteria of significant coronary artery stenosis were determined. The role of coronary flow reserve parameter in ischemia diagnosis and estimation of revascularization effectiveness and prognosis in patients with coronary heart disease was analyzed. The main indications for coronary flow reserve assessment in clinical practice were discussed.

Keywords:
transthoracic ultrasound assessment (transthoracic echocardiography), second tissue harmonic, coronary flow reserve, coronary artery stenosis, left anterior descending coronary artery, and right coron