Ogawa Shunichi, Ohkubo Takashi, Fukazawa Ryuji, Kamisago Mitsuhiro, Kuramochi Yukio, Uchikoba Yohko, Ikegami Ei, Watanabe Miki, Katsube Yasuhiro
Department of Pediatrics, Nippon Medical School Hospital, Tokyo, Japan.
J Am Coll Cardiol. 2004 Feb 18;43(4):653-61. doi: 10.1016/j.jacc.2003.10.032.
We used myocardial fractional flow reserve (FFR(myo)) and coronary flow reserve (CFR) to estimate cut-off values for assessment of the functional severity of coronary stenosis and myocardial ischemia, and we tested the usefulness of coronary blood hemodynamic measurements before and after plain old balloon angioplasty (POBA) and coronary artery bypass graft surgery (CABG).
Fractional flow reserve and CFR are useful for assessing the functional severity of coronary artery stenosis, coronary microvascular dysfunction, and myocardial ischemia during cardiac catheterization in adults. However, there have been no reports on the use of these measurements in children with Kawasaki disease (KD).
The study group included 128 patients with 314 coronary branches. The subjects were classified into three groups: normal coronary group, with 206 branches; abnormal coronary artery without ischemia group, with 58 branches; and ischemia group, with 50 branches.
In each branch, CFR and FFR(myo) were significantly lower in the ischemia group than in the other groups. Cut-off values for assessing the functional severity of coronary stenosis and CFR were approximately equal to those obtained for adults (CFR: <2.0; FFR(myo): <0.75). We obtained very high sensitivity and specificity for estimating myocardial ischemia using CFR and FFR(myo) (CFR: 94.0% and 98.5%, respectively; FFR(myo): 95.7% and 99.1%, respectively). Both CFR and FFR(myo) were reliable indicators of coronary hemodynamics before and after POBA and CABG.
Together, CFR and FFR(myo) provide a useful index for assessing the functional severity of coronary artery stenosis and myocardial ischemia and estimating the effectiveness of POBA and CABG in children with KD, the same as they do for adults.
我们使用心肌血流储备分数（FFR(myo)）和冠状动脉血流储备（CFR）来估算评估冠状动脉狭窄功能严重程度和心肌缺血的临界值，并测试了普通球囊血管成形术（POBA）和冠状动脉旁路移植术（CABG）前后冠状动脉血流动力学测量的效用。
血流储备分数和CFR有助于评估成人心脏导管插入术期间冠状动脉狭窄的功能严重程度、冠状动脉微血管功能障碍和心肌缺血。然而，尚无关于在川崎病（KD）患儿中使用这些测量方法的报道。
研究组包括128例患者，共314支冠状动脉分支。受试者分为三组：正常冠状动脉组，206支分支；无缺血的异常冠状动脉组，58支分支；缺血组，50支分支。
在各分支中，缺血组的CFR和FFR(myo)显著低于其他组。评估冠状动脉狭窄功能严重程度和CFR的临界值与成人获得的临界值大致相等（CFR：<2.0；FFR(myo)：<0.75）。我们使用CFR和FFR(myo)估算心肌缺血获得了非常高的敏感性和特异性（CFR分别为94.0%和98.5%；FFR(myo)分别为95.7%和99.1%）。CFR和FFR(myo)都是POBA和CABG前后冠状动脉血流动力学的可靠指标。
与成人一样，CFR和FFR(myo)共同为评估KD患儿冠状动脉狭窄功能严重程度和心肌缺血以及估算POBA和CABG的有效性提供了有用的指标。
