Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
JACC Cardiovasc Interv. 2012 Oct;5(10):1029-36. doi: 10.1016/j.jcin.2012.07.007.
The goal of this study was to identify clinical and lesion-specific local factors affecting visual-functional mismatch.
Although lesion severity determined by coronary angiography has not been well correlated with physiological significance, the mechanism of the discordance remains poorly understood.
The authors assessed quantitative coronary angiography, intravascular ultrasound (IVUS), and fractional flow reserve (FFR) in a prospective cohort of 1,000 patients with 1,129 coronary lesions. Three-dimensional computational simulation studies were performed.
Lesions with angiographic diameter stenosis (DS) ≥50% and FFR >0.80 ("mismatches") were seen in 57% of non-left main lesions and in 35% of the left main lesions, respectively (p = 0.032). Conversely, among the lesions with DS <50% and FFR <0.80 ("reverse mismatches") 16% were found in the non-left main lesions and 40% in the left main lesions (p < 0.001). The independent predictors for mismatch were advanced age, non-left anterior descending artery location, absence of plaque rupture, short lesion length, large minimal lumen area, smaller plaque burden, and greater minimal lumen diameter. Conversely, reverse mismatch was independently associated with younger age, left anterior descending artery location, the presence of plaque rupture, a smaller minimal lumen area, and larger plaque burden. In a computational simulation study, FFR was influenced by DS, lesion length, different lesion shape, plaque eccentricity, surface roughness, and various shapes of plaque rupture.
There were high frequencies of visual-functional mismatch between angiography and FFR. The discrepancy was related to the clinical and lesion-specific factors frequently unrecognizable by angiography, thus suggesting that coronary angiography cannot accurately predict FFR. (Natural History of FFR-Guided Deferred Coronary Lesions [IRIS FFR-DEFER]; NCT01366404).
本研究旨在确定影响视觉功能不匹配的临床和病变特异性局部因素。
尽管冠状动脉造影确定的病变严重程度与生理意义相关性不佳，但这种不匹配的机制仍知之甚少。
作者对 1000 例患者的 1129 个冠状动脉病变进行了前瞻性队列研究，评估了定量冠状动脉造影、血管内超声（IVUS）和血流储备分数（FFR）。还进行了三维计算模拟研究。
非左主干病变中，有 57%的病变存在血管造影直径狭窄（DS）≥50%且 FFR>0.80（“不匹配”），左主干病变中，有 35%的病变存在这种情况（p=0.032）。相反，在 DS<50%且 FFR<0.80（“反向不匹配”）的病变中，非左主干病变中有 16%，左主干病变中有 40%（p<0.001）。不匹配的独立预测因素为年龄较大、非前降支部位、无斑块破裂、病变长度较短、最小管腔面积较大、斑块负荷较小和最小管腔直径较大。相反，反向不匹配与年龄较小、前降支部位、斑块破裂存在、最小管腔面积较小和斑块负荷较大有关。在一项计算模拟研究中，FFR 受到 DS、病变长度、不同病变形状、斑块偏心度、表面粗糙度以及各种斑块破裂形状的影响。
血管造影和 FFR 之间存在高频率的视觉功能不匹配。这种差异与血管造影通常无法识别的临床和病变特异性因素有关，这表明冠状动脉造影不能准确预测 FFR。（自然史 FFR 指导下延迟冠状动脉病变研究[IRIS FFR-DEFER]；NCT01366404）。
