通过压力导丝测量压力梯度和外周血流储备分数用于诊断中度狭窄的髂股动脉疾病的验证

Validation of pressure gradient and peripheral fractional flow reserve measured by a pressure wire for diagnosis of iliofemoral artery disease with intermediate stenosis.

作者信息

Murata Naotaka, Aihara Hideaki, Soga Yoshimitsu, Tomoi Yusuke, Hiramori Seiichi, Kobayashi Yohei, Ichihashi Kei, Tanaka Nobuhiro

机构信息

Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan.

Department of Cardiology, Tsukuba Medical Center Hospital, Ibaraki, Japan.

出版信息

Med Devices (Auckl). 2015 Nov 9;8:467-72. doi: 10.2147/MDER.S83768. eCollection 2015.

OBJECTIVE

To examine the pressure gradient and peripheral fractional flow reserve (pFFR) measured by a pressure wire as indicators of hemodynamic significance in iliofemoral angiographic intermediate stenosis.

BACKGROUND

The utility of pressure measurements using a pressure wire with vasodilators is unclear in cases with intermediate iliofemoral stenosis.

METHODS

The mean pressure gradient (MPG) and mean pressure ratio (MPR) were measured at baseline and after injection of isosorbide dinitrate in 23 lesions with angiographically intermediate iliofemoral stenosis. Patients with complex lesions, infrapopliteal artery lesions, chronic total occlusion, and surgical bypass grafts were excluded. Hyperemic MPR was considered equivalent to pFFR. Changes in parameters in response to vasodilators were assessed and correlations of peak systolic velocity ratio (PSVR) with hyperemic MPG and pFFR were examined using duplex ultrasound.

RESULTS

After injection of isosorbide dinitrate, hyperemic MPG increased significantly (from 9.0±5.7 to 16.3±6.2 mmHg; P<0.05) and hyperemic MPR (pFFR) decreased significantly (from 0.92±0.06 to 0.81±0.07; P<0.05). PSVR was significantly correlated with hyperemic MPG (R=0.52; P<0.05) and pFFR (R=-0.50; P<0.05). The optimal cut-off value of pFFR as an indicator of significant hemodynamic stenosis (PSVR >2.5) was 0.85 (area under the curve 0.72; sensitivity 94%; specificity 50%, P<0.05).

CONCLUSION

pFFR measured using a pressure wire is reliable for prediction of hemodynamic significance in iliofemoral intermediate stenosis.

目的

研究通过压力导丝测量的压力梯度和外周血流储备分数（pFFR）作为髂股动脉造影中度狭窄血流动力学意义指标的情况。

背景

在髂股动脉中度狭窄病例中，使用带血管扩张剂的压力导丝进行压力测量的效用尚不清楚。

方法

对23例髂股动脉造影显示中度狭窄的病变，在基线时以及注射硝酸异山梨酯后测量平均压力梯度（MPG）和平均压力比值（MPR）。排除有复杂病变、腘下动脉病变、慢性完全闭塞病变和外科旁路移植的患者。充血状态下的MPR被视为等同于pFFR。评估血管扩张剂作用下参数的变化，并使用双功超声检查收缩期峰值流速比值（PSVR）与充血状态下MPG和pFFR的相关性。

结果

注射硝酸异山梨酯后，充血状态下的MPG显著增加（从9.0±5.7 mmHg增至16.3±6.2 mmHg；P<0.05），充血状态下的MPR（pFFR）显著降低（从0.92±0.06降至0.81±0.07；P<0.05）。PSVR与充血状态下的MPG显著相关（R=0.52；P<0.05），与pFFR也显著相关（R=-0.50；P<0.05）。作为显著血流动力学狭窄指标（PSVR>2.5）的pFFR的最佳截断值为0.85（曲线下面积0.72；敏感性94%；特异性50%，P<0.05）。