Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, 00168 Rome, Italy.
Circ Cardiovasc Interv. 2013 Feb;6(1):29-36. doi: 10.1161/CIRCINTERVENTIONS.112.971101. Epub 2013 Jan 15.
Fractional flow reserve (FFR) specifically relates to the severity of a stenosis to the mass of tissue to be perfused. Accordingly, the larger the territory to be perfused, the greater the flow and the pressure gradient induced by maximal hyperemia. Although this notion may be considered intuitive, its unequivocal demonstration is still lacking. The aim of our study was to evaluate the influence of the amount of myocardium subtended to an intermediate stenosis on FFR, especially in relation to quantitative coronary angiography.
The severity of each lesion was assessed by FFR and 2-dimensional quantitative coronary angiography. The amount of jeopardized myocardium was evaluated using 3 validated scores specifically adapted to this aim: the Duke Jeopardy Score (DJS), the Myocardial Jeopardy Index (MJI), and the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) Lesion Score (ALS). The presence of a concomitant collateralized chronic total occlusion was also reported. A total of 213 intermediate coronary stenoses in 184 patients were enrolled. FFR values were correlated to minimal lumen diameter (r=0.34; P<0.0001) and diameter stenosis (r=-0.28; P<0.0001). FFR was inversely correlated with DJS, MJI, and ALS (r=-0.28, P<0.0001; r=-0.40, P<0.0001; and r=-0.34, P<0.0001). Lesions localized on proximal left anterior descending were related to significantly lower FFR values and to a higher rate of a positive FFR compared with those in distal left anterior descending, left circumflex, and right coronary arteries (0.80±0.09 versus 0.84±0.08 versus 0.88±0.09 versus 0.91±0.04; P<0.0001). The presence of a collateralized chronic total occlusion was associated with significantly lower FFR values (0.80±0.07 versus 0.85±0.09; P<0.005). At multivariate analysis MJI, minimal lumen diameter, and presence of a collateralized chronic total occlusion were confirmed as significant predictors of FFR.
A larger amount of perfused myocardium subtended by a stenosis is associated with a higher probability that an angiographically intermediate coronary stenosis is functionally significant.
血流储备分数（FFR）与狭窄对将要灌注的组织质量的严重程度有直接关系。因此，灌注的区域越大，最大充血时诱导的流量和压力梯度就越大。尽管这一概念可能被认为是直观的，但它仍然缺乏明确的证明。我们的研究目的是评估与定量冠状动脉造影相比，由中度狭窄所涉及的心肌量对 FFR 的影响，特别是在定量冠状动脉造影方面。
通过 FFR 和二维定量冠状动脉造影评估每个病变的严重程度。通过专门为此目的而制定的 3 个经过验证的评分来评估易损心肌的量：杜克危险评分（DJS）、心肌危险指数（MJI）和艾伯塔省冠心病预后评估项目（APPROACH）病变评分（ALS）。还报告了同时存在伴有侧支循环的慢性完全闭塞的情况。共纳入 184 例患者的 213 个中度冠状动脉狭窄。FFR 值与最小管腔直径（r=0.34；P<0.0001）和直径狭窄（r=-0.28；P<0.0001）相关。FFR 与 DJS、MJI 和 ALS 呈负相关（r=-0.28，P<0.0001；r=-0.40，P<0.0001；r=-0.34，P<0.0001）。与左前降支的近端病变相比，位于左前降支的远端、左旋支和右冠状动脉的病变与明显较低的 FFR 值和更高的 FFR 阳性率相关（0.80±0.09 比 0.84±0.08 比 0.88±0.09 比 0.91±0.04；P<0.0001）。存在伴有侧支循环的慢性完全闭塞与明显较低的 FFR 值相关（0.80±0.07 比 0.85±0.09；P<0.005）。多变量分析证实，MJI、最小管腔直径和伴有侧支循环的慢性完全闭塞是 FFR 的显著预测因素。
由狭窄所涉及的心肌量越大，提示在功能上，造影显示的中度冠状动脉狭窄越严重的可能性越高。
