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Methoden der funktionellen Koronardiagnostik

Methods of coronary functional assessment

  • Koronare Atherosklerose — Funktionelle Konsequenzen
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Zusammenfassung

Die funktionelle Koronardiagnostik befaßt sich mit dynamischen Veränderungen des koronaren Lumens und der Gefäßwand, des koronaren Blutflusses, intrakoronarer Drücke sowie der myokardialen Perfusion in Abhängigkeit von definierten pharmakologischen Interventionen. Die erhobenen Daten dienen einerseits der Charakterisierung physiologischer Regulationsmechanismen, andererseits der Aufdeckung pathophysiologischer Vorgänge und der Entwicklung therapeutischer Ansätze, insbesondere im Hinblick auf die Entstehung der koronaren Arteriosklerose. Hierzu bedient sie sich einer Reihe direkter (invasiver) und indirekter (nichtinvasiver) Untersuchungsverfahren. In die erste Gruppe fallen intrakoronare Doppler-Flußmessung, koronare Druckmessung, quantitative Koronarangiographie sowie intravaskulärer Ultraschall. In die zweite Gruppe fallen koronare Doppler-Echokardiographie, Positronenemissionstomographie, Myokardszintigraphie sowie Magnetresonanzbildgebung. Die verschiedenen Verfahren ergänzen einander aufgrund unterschiedlicher zugrundeliegender technischer und physiologischer Prinzipien. Die kombinierte koronarinvasive Funktionsuntersuchung im Herzkatheterlabor bietet die Möglichkeit einer simultanen Betrachtung von hochauflösender bildgebender Diagnostik und direkten physiologischen Messungen unter lokaler Applikation von Testsubstanzen. Der hohe zeitliche und apparative Aufwand sowie die notwendige Erfahrung des Untersuchers beschränken diese Methodik jedoch auf spezialisierte Zentren. Neben der Anwendung im Rahmen der grundlagenorientierten Forschung haben funktionelle Methoden mittlerweile auch Einzug in die klinische Routine gehalten und finden Verwendung unter anderem zur Evaluierung der hämodynamischen Wirksamkeit von Koronarveränderungen sowie der Erfolgskontrolle nach therapeutischen Interventionen im Herzkatheterlabor. Die Prinzipien und Einsatzmöglichkeiten der verschiedenen Methoden sowie ausgewählte Befunde werden dargestellt.

Summary

Functional evaluation of coronary vasomotion encompasses the assessment of dynamic changes in coronary lumen, vessel wall, blood flow, intracoronary pressure and myocardial perfusion in response to specific pharmacologic stimuli. These parameters are obtained to characterize mechanisms of physiologic regulation and to evaluate pathophysiologic processes and potential therapeutic strategies, especially with regard to the development of coronary atherosclerosis. To this end, a variety of direct (invasive) and indirect (non-invasive) diagnostic tools are employed. Among the invasive methods are registration of intracoronary Doppler flow, coronary pressure measurements, quantitative coronary angiography and intravascular ultrasound. The non-invasive modalities consist of coronary Doppler echocardiography, positron emission tomography, myocardial scintigraphy and magnetic resonance imaging. Because of the different technical and physiological principles involved, these methods are complementary by providing independent access to different aspects. The combined invasive functional testing as employed in the cardiac catheterization laboratory allows for a simultaneous synopsis of high-resolution coronary imaging and direct measurement of physiologic parameters during local application of defined pharmacologically active substances. However, the demands in terms of equipment, time and operator skills are high and limit this combined invasive approach to spezialized centers. Besides these research purposes, a number of functional methods has entered the clinical arena. They are employed to evaluate the hemodynamic significance of coronary lesions and to assess functional outcome of therapeutic interventions in the catheterization laboratory. The underlying principles and applications of the different methods are described and an overview of selected results is presented.

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  1. Medizinische Klinik IV (Kardiologie/Nephrologie) der Johann-Wolfgang-Goethe-Universität Frankfurt, Theodor-Stern-Kai 7, D-60590, Frankfurt am Main

    Mathias Elsner

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Elsner, M. Methoden der funktionellen Koronardiagnostik. Herz 23, 78–96 (1998). https://doi.org/10.1007/BF03044539

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