Erhard I, Rieber J, Jung P, Hacker M, Schiele T, Stempfle H-U, König A, Baylacher M, Theisen K, Siebert U, Klauss V
Dept. of Cardiology, Medizinische Poliklinik-Innenstadt, University of Munich, Ziemssenstr. 1, 80336 Munich, Germany.
Z Kardiol. 2005 May;94(5):321-7. doi: 10.1007/s00392-005-0213-6.
Fractional flow reserve (FFR) is a new but well established parameter for the hemodynamic evaluation of coronary stenoses. A FFR below 0.75 was validated as functionally significant in coronary one or two vessel disease. This study was designed to prospectively define the best FFR cut off value (BCV) in patients with multivessel disease using two noninvasive tests, myocardial perfusion scintigraphy (SPECT) and contrast-enhanced dobutamine stress echocardiography (DSE) as reference methods.
47 symptomatic patients (29 male, mean age 64+/-10 yrs) with angiographically intermediate coronary lesions (50-75% diameter stenosis) entered the study. DSE (5-40 microg/min/kg dobutamine) was performed after intravenous injection of a second generation transpulmonary contrast agent. SPECT (Tc-99m-MIBI) was done at peak stress. All tests (DSE, SPECT and FFR) were performed within 4 weeks.
SPECT yielded positive results in 15 and DSE in 16 patients, respectively. Mean FFR measured in the target lesion (RCA n=10; LAD n=22, RCX n=15) was 0.80+/-0.13. FFR was <0.75 in 15 patients. By performing a ROC analysis the BCV (highest sum of sensitivity and specificity) was found at 0.75. At this cut off value using both non-invasive tests as reference method, sensitivity and specificity were 83 and 77%.
In patients with multivessel disease, a FFR <0.75 identifies a hemodynamically relevant lesion as compared to DSE and SPECT. This study underlines that FFR criteria are also applicable in patients with complex coronary artery disease.
血流储备分数（FFR）是用于评估冠状动脉狭窄血流动力学的一个新的但已确立的参数。FFR低于0.75已被证实对于冠状动脉单支或双支病变具有功能学意义。本研究旨在以前瞻性方式确定多支血管病变患者的最佳FFR临界值（BCV），采用两种非侵入性检查，即心肌灌注闪烁扫描（SPECT）和对比增强多巴酚丁胺负荷超声心动图（DSE）作为参考方法。
47例有症状患者（29例男性，平均年龄64±10岁），冠状动脉造影显示为中度病变（直径狭窄50 - 75%）进入本研究。静脉注射第二代经肺造影剂后进行DSE（5 - 40微克/分钟/千克多巴酚丁胺）。在负荷高峰时进行SPECT（锝-99m-甲氧基异丁基异腈）检查。所有检查（DSE、SPECT和FFR）均在4周内完成。
SPECT在15例患者中得出阳性结果，DSE在16例患者中得出阳性结果。在靶病变（右冠状动脉n = 10；左前降支n = 22，回旋支n = 15）测得的平均FFR为0.80±0.13。15例患者的FFR < 0.75。通过进行ROC分析，发现BCV（敏感性和特异性之和最高）为0.75。以此临界值，以两种非侵入性检查作为参考方法时，敏感性和特异性分别为83%和77%。
在多支血管病变患者中，与DSE和SPECT相比，FFR < 0.75可识别出血流动力学相关病变。本研究强调FFR标准也适用于复杂冠状动脉疾病患者。
