梗死相关动脉的血流储备分数可在心肌梗死后早期识别无创心肌灌注成像上的可逆性缺损。
Fractional flow reserve of infarct-related arteries identifies reversible defects on noninvasive myocardial perfusion imaging early after myocardial infarction.
作者信息
Samady Habib, Lepper Wolfgang, Powers Eric R, Wei Kevin, Ragosta Michael, Bishop Gregory G, Sarembock Ian J, Gimple Lawrence, Watson Denny D, Beller George A, Barringhaus Kurt G
机构信息
Andreas Gruentzig Cardiovascular Center, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia 30322, USA.
出版信息
J Am Coll Cardiol. 2006 Jun 6;47(11):2187-93. doi: 10.1016/j.jacc.2006.01.065.
OBJECTIVES
We hypothesized that fractional flow reserve (FFR) of an infarct-related artery (IRA) early after myocardial infarction (MI) identifies inducible ischemia on noninvasive imaging.
BACKGROUND
Early after MI, IRAs frequently have angiographically indeterminant lesions. Whether FFR can detect reversible perfusion defects early after MI when dynamic microvascular abnormalities are present is not known.
METHODS
Rest and dipyridamole (DP)-stress 99mTc sestamibi single-photon emission computed tomography (SPECT) were performed in 48 patients 3.7 +/- 1.3 days after MI, with 23 patients undergoing concurrent myocardial contrast echocardiography (MCE). Angiography, FFR, and percutaneous coronary intervention (PCI) of the IRA (as necessary) were subsequently performed. Follow-up SPECT was performed 11 weeks after PCI to identify true reversibility on baseline SPECT.
RESULTS
The sensitivity, specificity, positive and negative predictive value, and concordance of FFR < or =0.75 for detecting reversibility on SPECT were 88%, 50%, 68%, 89%, and 71% (chi-square <0.001), respectively; which improved to 88%, 93%, 88%, 93%, and 91% (chi-square <0.001), respectively, for the detection of true reversibility. The corresponding values of FFR < or =0.75 for detecting reversibility on DP-MCE were 90%, 100%, 100%, 75%, and 93% (chi-square <0.001), respectively, and on either SPECT or MCE were 88%, 93%, 91%, 91%, and 91% (chi-square <0.001), respectively. The optimal FFR value for discriminating inducible ischemia on noninvasive imaging was 0.78.
CONCLUSIONS
Fractional flow reserve of the IRA accurately identifies reversibility on noninvasive imaging early after MI. These findings support the utility of FFR early after MI.
目的
我们假设心肌梗死（MI）后早期梗死相关动脉（IRA）的血流储备分数（FFR）可在无创成像中识别出可诱导的心肌缺血。
背景
MI后早期，IRA在血管造影上常表现为不确定病变。当存在动态微血管异常时，FFR能否在MI后早期检测到可逆性灌注缺损尚不清楚。
方法
对48例MI后3.7±1.3天的患者进行静息和双嘧达莫（DP）负荷99mTc 甲氧基异丁基异腈单光子发射计算机断层扫描（SPECT），其中23例患者同时接受心肌对比超声心动图（MCE）检查。随后对IRA进行血管造影、FFR测定及必要时的经皮冠状动脉介入治疗（PCI）。PCI术后11周进行随访SPECT，以确定基线SPECT上的真正可逆性。
结果
FFR≤0.75检测SPECT上可逆性的敏感性、特异性、阳性和阴性预测值及一致性分别为88%、50%、68%、89%和71%（卡方检验<0.001）；检测真正可逆性时分别提高到88%、93%、88%、93%和91%（卡方检验<0.001）。FFR≤0.75检测DP-MCE上可逆性的相应值分别为90%、100%、100%、75%和93%（卡方检验<0.001），检测SPECT或MCE上可逆性的相应值分别为88%、93%、91%、91%和91%（卡方检验<0.001）。鉴别无创成像中可诱导心肌缺血的最佳FFR值为0.78。
结论
IRA的FFR可准确识别MI后早期无创成像中的可逆性。这些发现支持MI后早期FFR 的实用性。
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