Tanaka Kentaro, Bezerra Hiram G, Gaur Sara, Attizzani Guilherme F, Bøtker Hans Erik, Costa Marco A, Rogers Campbell, Nørgaard Bjarne L
Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH, 44106, USA.
Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark.
Ann Biomed Eng. 2016 Feb;44(2):580-9. doi: 10.1007/s10439-015-1436-y. Epub 2015 Sep 2.
Fractional flow reserve (FFR) has been established as gold standard to detect hemodynamically significant coronary artery disease. Non-invasive FFR derived from coronary computed tomography angiography (CTA; FFRCT) has demonstrated higher diagnostic performance compared with FFR. However, the accuracy and potential advantages of FFRCT compared with invasive FFR in coronary arteries with serial lesions have not been examined. The aim of this study was to compare trans-lesional gradient in FFRCT to that in invasive FFR in coronary arteries with serial stenoses. Eighteen vessels with serial coronary lesions from 18 stable angina patients were evaluated with angiography, FFR, and coronary CTA. FFRCT was computed from 3-dimensional CT model and coronary flow dynamics data. Multiple FFRCT values were co-registered with measured FFR across the lesions, and trans-lesional delta were compared between FFRCT and FFR. The mean values of the most distal FFR and FFRCT in the same co-registered regions were 0.72 ± 0.10 and 0.69 ± 0.11, respectively. In 13 vessels (72.2%), FFR was ≤0.80, while in 14 vessels (77.8%), FFRCT was ≤0.80. Trans-lesional delta FFR and FFRCT were 0.10 ± 0.09 and 0.09 ± 0.10 in distal segments, while 0.17 ± 0.10 and 0.22 ± 0.13 in proximal segments, respectively. The coefficient of correlation between trans-lesional delta FFR and FFRCT in each segment was 0.92 (p < 0.001). Trans-lesional delta FFR and FFRCT show an excellent correlation. Further studies are required to determine the diagnostic accuracy and clinical impact of our findings.
血流储备分数（FFR）已被确立为检测具有血流动力学意义的冠状动脉疾病的金标准。源自冠状动脉计算机断层扫描血管造影（CTA；FFRCT）的无创FFR已显示出比FFR更高的诊断性能。然而，在存在串联病变的冠状动脉中，FFRCT与有创FFR相比的准确性和潜在优势尚未得到检验。本研究的目的是比较存在串联狭窄的冠状动脉中FFRCT的跨病变梯度与有创FFR的跨病变梯度。对18例稳定型心绞痛患者的18条存在串联冠状动脉病变的血管进行了血管造影、FFR和冠状动脉CTA评估。FFRCT由三维CT模型和冠状动脉血流动力学数据计算得出。多个FFRCT值与病变处测得的FFR进行共同配准，并比较FFRCT和FFR之间的跨病变差值。在相同共同配准区域中，最远端FFR和FFRCT的平均值分别为0.72±0.10和0.69±0.11。在13条血管（72.2%）中，FFR≤0.80，而在14条血管（77.8%）中，FFRCT≤0.80。远端节段的跨病变FFR和FFRCT差值分别为0.10±0.09和0.09±0.10，而近端节段分别为0.17±0.10和0.22±0.13。各节段跨病变FFR和FFRCT差值之间的相关系数为0.92（p<0.001）。跨病变FFR和FFRCT显示出极好的相关性。需要进一步研究以确定我们研究结果的诊断准确性和临床影响。
