冠状动脉造影或血管内超声与血流储备分数之间的视觉-功能不匹配的性别差异。
Sex differences in the visual-functional mismatch between coronary angiography or intravascular ultrasound versus fractional flow reserve.
机构信息
Department of Cardiology, University of Ulsan College of Medicine Asan Medical Center, Seoul, South Korea.
出版信息
JACC Cardiovasc Interv. 2013 Jun;6(6):562-8. doi: 10.1016/j.jcin.2013.02.016.
OBJECTIVES
This study sought to assess differences in visual-functional mismatches between men and women.
BACKGROUND
Sex differences in mismatch between coronary anatomy and function remain poorly understood.
METHODS
We assessed quantitative coronary angiography, intravascular ultrasound (IVUS), fractional flow reserve (FFR), and echocardiographic left ventricular mass in a prospective cohort of 700 patients (493 male and 207 female patients) with 700 left anterior descending coronary lesions.
RESULTS
The female patients were older than the male patients (64 ± 10 years vs. 60 ± 10 years, p < 0.001) and body surface area (BSA) (57 ± 0.13 m(2) vs. 1.79 ± 0.13 m(2), p < 0.001) and left ventricular mass (151 ± 37g vs. 171 ± 41 g, p < 0.001) were smaller. Although there were no sex differences in angiographic diameter stenosis, lesion length, and IVUS minimal lumen area (MLA), FFR was higher in female patients (0.83 ± 0.09 vs. 0.79 ± 0.09, p < 0.001). Female patients had a smaller reference vessel area (11.4 ± 3.3 mm(2) vs. 13.1 ± 4.0 mm(2)), vessel area (9.0 ± 3.3 mm(2) vs. 11.1 ± 4.2 mm(2)), and plaque burden (69.8 ± 13.7% vs. 73.8 ± 12.2%) at the MLA site compared with male patients (all p < 0.001). To predict FFR <0.80, angiography had a lower positive predictive value in female patients (44% vs. 60%, p = 0.014); this was also seen in the IVUS analysis. Unlike angiography, the IVUS-MLA had a lower concordance rate in female patients (64% vs. 71%, p = 0.046). Independent predictors of FFR were age, BSA, lesion length, angiographic diameter stenosis, and IVUS-MLA and plaque burden. When left ventricular mass was included, it also predicted FFR, replacing BSA.
CONCLUSIONS
In female patients with smaller BSA, left ventricular mass, and vessel size, smaller myocardial territory may be responsible for the higher FFR value for any given stenosis compared with male patients. Considering the higher rate of visual-functional mismatch, FFR-guided decision making is especially important in female patients to avoid unnecessary procedures. (Natural History of FFR-Guided Deferred Coronary Lesions [IRIS FFR-DEFER Registry]; NCT01366404).
目的
本研究旨在评估男性和女性之间的冠状动脉解剖结构与功能不匹配的视觉功能差异。
背景
冠状动脉解剖结构与功能之间的性别差异仍未得到很好的理解。
方法
我们对前瞻性队列中的 700 例患者（493 例男性和 207 例女性）的 700 例左前降支病变进行了定量冠状动脉造影、血管内超声（IVUS）、血流储备分数（FFR）和超声心动图左心室质量评估。
结果
与男性患者（64±10 岁）相比，女性患者年龄更大（64±10 岁），身体表面积（BSA）更小（57±0.13m²），左心室质量（151±37g）也更小（171±41g）。尽管在血管造影直径狭窄、病变长度和 IVUS 最小管腔面积（MLA）方面没有性别差异，但女性患者的 FFR 更高（0.83±0.09 vs. 0.79±0.09，p<0.001）。与男性患者相比，女性患者在 MLA 部位的参考血管面积（11.4±3.3mm²）、血管面积（9.0±3.3mm²）和斑块负荷（69.8±13.7%）较小（均 p<0.001）。与男性患者相比，血管造影术在预测 FFR<0.80 方面对女性患者的阳性预测值较低（44% vs. 60%，p=0.014）；在 IVUS 分析中也可以看到这种情况。与血管造影术不同，IVUS-MLA 在女性患者中的一致性较低（64% vs. 71%，p=0.046）。FFR 的独立预测因素为年龄、BSA、病变长度、血管造影直径狭窄、IVUS-MLA 和斑块负荷。当纳入左心室质量时，它也可以预测 FFR，取代 BSA。
结论
在 BSA、左心室质量和血管尺寸较小的女性患者中，与男性患者相比，较小的心肌区域可能是导致特定狭窄程度下 FFR 值较高的原因。考虑到视觉功能不匹配的发生率较高，FFR 指导下的决策对于女性患者尤为重要，以避免不必要的程序。（自然病史的 FFR 指导下的延迟冠状动脉病变[IRIS FFR-DEFER 登记处]；NCT01366404）。
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