Saito Naritatsu, Matsuo Hitoshi, Kawase Yoshiaki, Watanabe Shin, Bao Bingyuan, Yamamoto Erika, Watanabe Hiroki, Nakatsuma Kenji, Ueno Katsumi, Kimura Takeshi
Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan.
J Invasive Cardiol. 2013 Dec;25(12):642-9.
Myocardial fractional flow reserve (FFR) is a reliable index in coronary intervention. A simple FFR measurement does not predict the true functional severity of an individual stenosis in multiple sequential coronary stenoses because of complex interaction between the stenoses. Application of the theoretical equations to predict the true FFR of individual stenosis is limited in a tandem lesion. Two novel equations applicable to a multiple sequential coronary stenoses are mathematically derived. One predicts the true FFR of each stenosis (equation A), and the other predicts the true FFR after releasing a given stenosis (equation B). The present study aimed to validate the two derived equations in an in vitro model of coronary circulation.
Predictive FFR was compared with true FFR in an in vitro model of three sequential stenoses using linear regression analysis. The difference between apparent FFR and true FFR was compared with the difference between predictive FFR and true FFR. The legitimacy of equation A was first assessed. A close correlation was found between predictive FFR and true FFR (r² = 0.92). The difference between predictive FFR and true FFR was significantly lower compared to the difference between apparent FFR and true FFR (0.18 ± 0.10 vs 0.05 ± 0.05; P<.001). The legitimacy of equation B was also assessed, and a close correlation was found (r² = 0.97). The difference was significantly lower when we applied equation B (0.13 ± 0.06 vs 0.04 ± 0.02; P<.001).
Equations A and B strongly predict the true value of FFR in the experimental model of coronary circulation.
心肌血流储备分数（FFR）是冠状动脉介入治疗中的一个可靠指标。由于狭窄之间存在复杂的相互作用，简单的FFR测量无法预测多个连续冠状动脉狭窄中单个狭窄的真正功能严重程度。在串联病变中，应用理论方程预测单个狭窄的真实FFR受到限制。通过数学推导得出了两个适用于多个连续冠状动脉狭窄的新方程。一个预测每个狭窄的真实FFR（方程A），另一个预测在解除给定狭窄后的真实FFR（方程B）。本研究旨在在冠状动脉循环的体外模型中验证这两个推导方程。
使用线性回归分析，在三个连续狭窄的体外模型中比较预测FFR与真实FFR。比较表观FFR与真实FFR之间差值和预测FFR与真实FFR之间差值。首先评估方程A的合理性。发现预测FFR与真实FFR之间存在密切相关性（r² = 0.92）。与表观FFR和真实FFR之间的差值相比，预测FFR与真实FFR之间的差值显著更低（0.18±0.10对0.05±0.05；P<.001）。还评估了方程B的合理性，发现存在密切相关性（r² = 0.97）。应用方程B时差值显著更低（0.13±0.06对0.04±0.02；P<.001）。
方程A和方程B在冠状动脉循环的实验模型中能有力地预测FFR的真实值。
