Takashima Hiroaki, Waseda Katsuhisa, Gosho Masahiko, Kurita Akiyoshi, Ando Hirohiko, Sakurai Shinichiro, Maeda Kazuyuki, Kumagai Soichiro, Suzuki Akihiro, Amano Tetsuya
Department of Cardiology, Aichi Medical University, Aichi, Japan.
Department of Cardiology, Aichi Medical University, Aichi, Japan.
J Cardiol. 2015 Sep;66(3):239-45. doi: 10.1016/j.jjcc.2014.11.004. Epub 2014 Dec 26.
Although functional ischemia identification is important when determining revascularization, angiographic assessment alone is challenging in intermediate coronary stenosis. Previous studies have reported that lesion-specific characteristics affected the fractional flow reserve (FFR). However, the relationship between morphological lesion complexity and FFR has not yet been fully evaluated. This study aimed to evaluate the impact of morphological lesion complexity on FFR in intermediate coronary stenosis.
A total of 109 consecutive patients with 136 intermediate coronary stenoses (visually estimated diameter stenosis: 40-70%) were assessed via quantitative coronary angiography, lesion-specific characteristics, and FFR. Indexed lesions were assessed according to 6 morphological lesion characteristics: eccentricity, bend, irregularity, calcification, bifurcation, and diffuse. The lesions were then classified into 3 groups according to the morphological severity count represented by the number of present characteristics (mild-complex: 0-1, moderate-complex: 2-3, and severe-complex: 4-6), and their functional severities were evaluated. Lesions with an FFR <0.80 were considered functionally significant coronary stenoses.
Of the 136 lesions, 51% were located in the left anterior descending artery (LAD) and 47% had an FFR <0.80. The FFR differed significantly among the 3 lesion complexity groups (0.84±0.10 vs. 0.79±0.10 vs. 0.73±0.07, for mild-, moderate-, and severe-complex, respectively; p<0.01). In a multivariate logistic analysis, LAD lesions, moderate- and severe-complex, and diameter stenosis were independently associated with an FFR <0.80 [odds ratio (OR): 5.65, 95% confidence interval (CI): 2.50-12.80, p<0.01; OR: 2.96, 95% CI: 1.30-6.72, p<0.01; OR: 7.11, 95% CI: 1.25-40.37, p=0.03, and OR: 2.65, 95% CI: 1.04-6.72, p=0.04, respectively].
Both indexed vessels and the degree of diameter stenosis affected the FFR. In addition, the severity of morphological lesion complexity correlated with the degree of functional severity in intermediate coronary stenosis.
尽管在确定血运重建时，功能性缺血的识别很重要，但对于中度冠状动脉狭窄，仅靠血管造影评估具有挑战性。既往研究报道，病变特异性特征会影响血流储备分数（FFR）。然而，形态学病变复杂性与FFR之间的关系尚未得到充分评估。本研究旨在评估形态学病变复杂性对中度冠状动脉狭窄患者FFR的影响。
连续纳入109例患者，共136处中度冠状动脉狭窄（目测直径狭窄：40%-70%），通过定量冠状动脉造影、病变特异性特征及FFR进行评估。根据6种形态学病变特征对索引病变进行评估：偏心性、弯曲度、不规则性、钙化、分叉及弥漫性。然后根据存在特征数量所代表的形态学严重程度计数将病变分为3组（轻度复杂：0-1个特征，中度复杂：2-3个特征，重度复杂：4-6个特征），并评估其功能严重程度。FFR<0.80的病变被认为是功能性显著冠状动脉狭窄。
在136处病变中，51%位于左前降支（LAD），47%的病变FFR<0.80。3组病变复杂性组的FFR差异有统计学意义（轻度复杂组、中度复杂组和重度复杂组分别为0.84±0.10、0.79±0.10和0.73±0.07；p<0.01）。多因素logistic分析显示，LAD病变、中度和重度复杂病变以及直径狭窄与FFR<0.80独立相关[比值比（OR）：5.65，95%置信区间（CI）：2.50-12.80，p<0.01；OR：2.96，95%CI：1.30-6.72，p<0.01；OR：7.11，95%CI：1.25-40.37，p=0.03，以及OR：2.65，95%CI：1.04-6.72，p=0.04]。
索引血管和直径狭窄程度均影响FFR。此外，在中度冠状动脉狭窄中，形态学病变复杂性的严重程度与功能严重程度相关。
