血管内超声预测中度左主干病变的血流储备分数。

Intravascular ultrasound-derived predictors for fractional flow reserve in intermediate left main disease.

机构信息

Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.

出版信息

JACC Cardiovasc Interv. 2011 Nov;4(11):1168-74. doi: 10.1016/j.jcin.2011.08.009.

DOI:10.1016/j.jcin.2011.08.009

PMID:22115656

Abstract

OBJECTIVES

The aim of this study was to determine the best intravascular ultrasound (IVUS) criteria for predicting physiological significance of left main (LM) stenosis with fractional flow reserve (FFR) as the standard.

BACKGROUND

For identifying significant LM disease, optimal cutoff of minimal lumen area (MLA) and its accuracy remain debatable.

METHODS

We identified 55 patients (31 stable and 24 unstable angina) with an isolated LM lesion of 30% to 80% angiographic diameter stenosis who underwent IVUS and invasive physiological assessment before intervention.

RESULTS

The FFR at maximum hyperemia significantly correlated with IVUS-measured MLA within the LM (r = 0.623, p < 0.001), plaque burden (r = -0.548, p < 0.001), angiographic diameter stenosis (r = -0.449, p = 0.002), and angiographic length of the lesion (r = -0.292, p = 0.046). The FFR was significantly lower in 18 lesions with plaque rupture than 37 lesions without plaque rupture (0.76 ± 0.09 vs. 0.82 ± 0.09, p = 0.018). The independent determinants of FFR as a continuous variable were MLA (beta = 0.598, p < 0.001) and plaque rupture (beta = -0.255, p = 0.038). Furthermore, the MLA within the LM was the only independent determinant for FFR <0.80 (adjusted odds ratio: 0.312, p < 0.001) and for FFR <0.75 (adjusted odds ratio: 0.196, p = 0.001). The IVUS MLA value within the LM that best predicted FFR <0.80 was <4.8 mm(2) (89% sensitivity, 83% specificity). In addition, the cutoff value of plaque burden to predict FFR <0.80 was ≥72% (73% sensitivity, 79% specificity). The best cutoff values of the MLA and plaque burden for predicting FFR <0.75 were <4.1 mm(2) (95% sensitivity, 83% specificity) and ≥76% (79% sensitivity, 80% specificity), respectively.

CONCLUSIONS

In isolated LM disease, an IVUS-derived MLA <4.8 mm(2) is a useful criterion for predicting FFR <0.80.

摘要

目的

本研究旨在确定最佳的血管内超声（IVUS）标准，以预测左主干（LM）狭窄的生理意义，以血流储备分数（FFR）作为标准。

背景

对于识别有意义的 LM 疾病，最小管腔面积（MLA）的最佳截断值及其准确性仍存在争议。

方法

我们纳入了 55 名患者（31 名稳定性心绞痛和 24 名不稳定型心绞痛），这些患者均存在 30%-80%的 LM 狭窄程度的孤立性 LM 病变，且均接受了 IVUS 和介入前的有创生理评估。

结果

最大充血时的 FFR 与 LM 内 IVUS 测量的 MLA（r=0.623，p<0.001）、斑块负荷（r=-0.548，p<0.001）、血管造影直径狭窄（r=-0.449，p=0.002）和血管造影病变长度（r=-0.292，p=0.046）显著相关。与 37 名无斑块破裂的病变相比，18 名有斑块破裂的病变中 FFR 显著降低（0.76±0.09 vs. 0.82±0.09，p=0.018）。FFR 作为连续变量的独立决定因素是 MLA（β=0.598，p<0.001）和斑块破裂（β=-0.255，p=0.038）。此外，LM 内的 MLA 是预测 FFR<0.80（调整后比值比：0.312，p<0.001）和 FFR<0.75（调整后比值比：0.196，p=0.001）的唯一独立决定因素。预测 FFR<0.80 的 LM 内最佳 IVUS MLA 值为<4.8mm2（89%的敏感性，83%的特异性）。此外，预测 FFR<0.80 的斑块负荷的最佳截断值为≥72%（73%的敏感性，79%的特异性）。预测 FFR<0.75 的 MLA 和斑块负荷的最佳截断值分别为<4.1mm2（95%的敏感性，83%的特异性）和≥76%（79%的敏感性，80%的特异性）。