Pattanshetty Deepak J, Bhat Pradeep K, Gandhi Sanjay, Pillai Dilip P, Aneja Ashish
Case Western Reserve University, MetroHealth Campus, Cleveland, OH, USA.
Case Western Reserve University, MetroHealth Campus, Cleveland, OH, USA.
Indian Heart J. 2015 Jan-Feb;67(1):50-5. doi: 10.1016/j.ihj.2015.02.010. Epub 2015 Feb 25.
FFR provides an accurate and reproducible assessment of the functional severity of coronary stenosis. Whereas stress testing remains the preferred initial modality for assessment of ischemia, there is limited data comparing it with FFR. We sought to determine the correlation between cardiac stress testing and coronary fractional flow reserve (FFR) measurement for assessing the presence, location, and burden of myocardial ischemia in patients referred for evaluation of coronary artery disease (CAD).
Over 5-year study period, of the 5420 consecutive coronary angiograms that were screened, 326 patients had FFR measurements. Of these, 96 patients with FFR measurements who had a preceding stress test (stress echocardiography [SE] or myocardial perfusion imaging [MPI]) within a year were included.
Of the 96 patients, there were 46 (48%) men and 50 (52%) women with a mean age of 61 ± 10 years. SE was performed in 57 (59.3%) and MPI in 32 (40.7%) of patients. FFR was ≤0.79 in 54 (56%) patients. Stress testing had low sensitivity (55%) and specificity (47%) compared to FFR. The concordance between FFR and stress testing was low for both presence (k=0.03) and location (k=0.05) of the ischemic territory. The number of ischemic vascular territories was correctly estimated in only 39% of the stress tests. SE was more likely to overestimate and MPI more likely to underestimate extent of ischemia.
In patients referred for evaluation of CAD, there was poor correlation between stress testing and FFR. A prospective study comparing these two modalities with FFR is needed.
血流储备分数（FFR）可对冠状动脉狭窄的功能严重程度进行准确且可重复的评估。虽然负荷试验仍是评估心肌缺血的首选初始方法，但将其与FFR进行比较的数据有限。我们试图确定心脏负荷试验与冠状动脉血流储备分数（FFR）测量之间的相关性，以评估因冠状动脉疾病（CAD）接受评估的患者心肌缺血的存在、位置和负担。
在为期5年的研究期间，在筛查的5420例连续冠状动脉造影中，326例患者进行了FFR测量。其中，96例在一年内进行过负荷试验（负荷超声心动图[SE]或心肌灌注成像[MPI]）的患者纳入研究。
96例患者中，男性46例（48%），女性50例（52%），平均年龄61±10岁。57例（59.3%）患者进行了SE，32例（40.7%）患者进行了MPI。54例（56%）患者的FFR≤0.79。与FFR相比，负荷试验的敏感性（55%）和特异性（47%）较低。对于缺血区域的存在（k=0.03）和位置（k=0.05），FFR与负荷试验之间的一致性较低。仅39%的负荷试验正确估计了缺血血管区域的数量。SE更有可能高估缺血范围，而MPI更有可能低估缺血范围。
在因CAD接受评估的患者中，负荷试验与FFR之间的相关性较差。需要进行一项前瞻性研究，将这两种方法与FFR进行比较。
