Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands.
Neth Heart J. 2007;15(11):369-74. doi: 10.1007/BF03086017.
In this multicentre study, we investigated the long-term prognostic value of intracoronary derived haemodynamic parameters compared with the results of myocardial perfusion scintigraphy (MPS).
Patients (n=191) who were referred for angioplasty of a severe lesion in the presence of an intermediate lesion in another coronary artery were included. MPS was performed to determine the presence of reversible perfusion defects in the area of the intermediate lesion. Coronary flow velocity reserve (CFVR), and additionally fractional flow reserve (FFR; n=129), were determined distal to the intermediate lesion; CFVR >/=2.0 and FFR >/=0.75 were considered negative.
In total 67 events occurred in 49 patients (3 deaths, 9 MI, 9 CABG, 46 PTCA) during a mean of 793 days follow-up. Event-free survival was 63% for MPS, 79% for CFVR, and 79% for FFR if a negative test result was obtained. The relative risk was 1.2 (not significant) for MPS, 2.2 (p=0.001) for CFVR, and 2.4 (p=0.004) for FFR.
Selective evaluation of an intermediate lesion using CFVR or FFR allows more adequate risk stratification in patients with multivessel disease than MPS. A CFVR <2.0 or a FFR <0.75 was associated with a significant increase of the occurrence of cardiac events during long-term follow-up, predominantly associated with revascularisation. (Neth Heart J 2007;15:369-74.).
在这项多中心研究中，我们研究了与心肌灌注闪烁显像（MPS）结果相比，冠状动脉内血流动力学参数的长期预后价值。
纳入了 191 例因另一支冠状动脉中的中度狭窄病变而接受血管成形术的患者。进行 MPS 以确定中度狭窄病变区域是否存在可逆性灌注缺损。在中度狭窄病变的远端测定冠状动脉血流储备分数（CFVR），并（n=129）测定血流储备分数（FFR）；CFVR≥2.0 和 FFR≥0.75 被认为是阴性结果。
在平均 793 天的随访期间，共有 49 例患者（3 例死亡，9 例心肌梗死，9 例 CABG，46 例 PTCA）发生了 67 例事件。如果获得阴性检测结果，MPS 的无事件生存率为 63%，CFVR 为 79%，FFR 为 79%。MPS 的相对风险为 1.2（无统计学意义），CFVR 为 2.2（p=0.001），FFR 为 2.4（p=0.004）。
与 MPS 相比，使用 CFVR 或 FFR 选择性评估中度狭窄病变可对多血管疾病患者进行更充分的风险分层。CFVR<2.0 或 FFR<0.75 与长期随访期间心脏事件发生率的显著增加相关，主要与血运重建相关。（荷兰心脏杂志 2007；15:369-74.）。
