下游冠状动脉狭窄对中间左主干冠状动脉疾病的血流储备分数评估的影响：人体验证。

The impact of downstream coronary stenosis on fractional flow reserve assessment of intermediate left main coronary artery disease: human validation.

机构信息

Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, California.

出版信息

JACC Cardiovasc Interv. 2015 Mar;8(3):398-403. doi: 10.1016/j.jcin.2014.09.027.

DOI:10.1016/j.jcin.2014.09.027

PMID:25790763

Abstract

OBJECTIVES

The aim of this study was to determine the impact of downstream coronary stenosis in the left anterior descending coronary artery (LAD) or left circumflex coronary artery (LCx) on the assessment of fractional flow reserve (FFR) across an intermediate left main coronary artery (LMCA) stenosis in humans with the pressure wire positioned in the nondiseased downstream vessel.

BACKGROUND

Accurate assessment of intermediate LMCA disease is critical for guiding decisions regarding revascularization. In theory, FFR across an intermediate LMCA stenosis will be affected by downstream disease, even if the pressure wire is positioned in the nondiseased downstream vessel.

METHODS

After percutaneous coronary intervention of the LAD, LCx, or both, an intermediate LMCA stenosis was created with a deflated balloon catheter. FFR was measured in the LAD and LCx coronary arteries before and after creation of downstream stenosis by inflating an angioplasty balloon within the newly placed stent. The true FFR (FFRtrue) of the LMCA, measured in the nondiseased downstream vessel in the absence of stenosis in the other vessel, was compared with the apparent FFR (FFRapp) measured in the presence of stenosis.

RESULTS

In 25 patients, 91 pairs of measurements were made, 71 with LAD stenosis and 20 with LCx stenosis. FFRtrue of the LMCA was significantly lower than FFRapp (0.81 ± 0.08 vs. 0.83 ± 0.08, p < 0.001), although the numerical difference was small. This difference correlated with the severity of the downstream disease (r = 0.35, p < 0.001). In all cases in which FFRapp was >0.85, FFRtrue was >0.80.

CONCLUSIONS

In most cases, downstream disease does not have a clinically significant impact on the assessment of FFR across an intermediate LMCA stenosis with the pressure wire positioned in the nondiseased vessel.

摘要

目的

本研究旨在确定左前降支（LAD）或左旋支（LCx）下游的冠状动脉狭窄对压力导丝置于非病变下游血管时中间左主干冠状动脉（LMCA）狭窄处的血流储备分数（FFR）评估的影响。

背景

准确评估中间 LMCA 病变对于指导血运重建决策至关重要。理论上，即使压力导丝置于非病变下游血管，中间 LMCA 狭窄处的 FFR 也会受到下游疾病的影响。

方法

在经皮冠状动脉介入治疗 LAD、LCx 或两者后，用瘪气球导管造成中间 LMCA 狭窄。在新放置的支架内充气球囊扩张造成下游狭窄前后，分别在 LAD 和 LCx 冠状动脉中测量 FFR。在另一支血管无狭窄的情况下，在无病变的下游血管中测量真实的 LMCA FFR（FFRtrue），并与存在狭窄时测量的表观 FFR（FFRapp）进行比较。

结果

在 25 例患者中，共进行了 91 对测量，其中 71 例存在 LAD 狭窄，20 例存在 LCx 狭窄。LMCA 的 FFRtrue 明显低于 FFRapp（0.81±0.08 比 0.83±0.08，p<0.001），尽管数值差异较小。这种差异与下游疾病的严重程度相关（r=0.35，p<0.001）。在 FFRapp>0.85 的所有情况下，FFRtrue>0.80。