Takami Hironori, Sonoda Shinjo, Muraoka Yoshitaka, Sanuki Yoshinori, Kashiyama Kuninobu, Fukuda Shota, Oginosawa Yasushi, Tsuda Yuki, Araki Masaru, Otsuji Yutaka
Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.
Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.
J Cardiol. 2017 Jan;69(1):119-124. doi: 10.1016/j.jjcc.2016.01.018. Epub 2016 Mar 2.
Fractional flow reserve (FFR) is a useful index for determining the functional severity of epicardial coronary artery stenosis as an invasive physiological method. Although intravenous adenosine 5'-triphosphate (ATP) is generally used as a hyperemic agent for FFR measurement in Japan, there are some concerns about the variability of FFR measurement (short half-life, effect of caffeine, cyclic change). It is difficult to confirm sufficient maximum hyperemia after ATP infusion. Recent studies reported that nicorandil (NIC) could be an alternative to ATP as a hyperemic agent.
Patients who underwent FFR assessments of angiographically intermediate lesions were included. All patients were asked to refrain from caffeine-containing products more than 12hours before FFR measurements. All patients first received intravenous (IV) ATP infusion (180μg/kg/min) for 3min to measure FFR (ATP-FFR). After additional intracoronary (IC) NIC administration (2mg/30s) during ATP infusion, FFR was measured again (NIC-FFR). To check cyclic change in FFR, we measured minimum and maximum FFR values during both ATP and NIC hyperemic phase.
In this study, 94 patients with 94 lesions were enrolled. Mean FFR value was 0.81±0.10 in ATP-FFR infusion and 0.80±0.09 in NIC-FFR, respectively. ATP-FFR and NIC-FFR had a strong correlation on the whole (r=0.92, p<0.001). In 18 patients (19%), FFR values were significantly lower in NIC-FFR than in ATP-FFR. In one-third of those patients (6%), it was possible to change therapeutic strategy from deferral range (>0.80) to interventional range (≦0.80) after NIC-FFR measurements. Cyclic change in FFR was smaller in NIC-FFR than in ATP-FFR (0.03±0.02 vs. 0.06±0.05, p<0.0001).
Additional IC NIC might be useful to confirm sufficient maximum hyperemia after IV ATP infusion in daily clinical practice. Furthermore, IC NIC could reduce cyclic change in FFR; thus, physicians might find it easier to determine FFR value during the procedure.
血流储备分数（FFR）作为一种有创生理方法，是用于确定心外膜冠状动脉狭窄功能严重程度的有用指标。在日本，虽然静脉注射5'-三磷酸腺苷（ATP）通常用作FFR测量的充血剂，但人们对FFR测量的变异性（半衰期短、咖啡因的影响、周期性变化）存在一些担忧。在ATP输注后很难确认达到足够的最大充血状态。最近的研究报告称，尼可地尔（NIC）可作为ATP的替代充血剂。
纳入接受血管造影显示为中等病变的FFR评估的患者。所有患者在FFR测量前12小时以上被要求避免使用含咖啡因的产品。所有患者首先接受静脉（IV）ATP输注（180μg/kg/min）3分钟以测量FFR（ATP-FFR）。在ATP输注期间额外进行冠状动脉内（IC）尼可地尔给药（2mg/30s）后，再次测量FFR（NIC-FFR）。为检查FFR的周期性变化，我们在ATP和NIC充血期测量了最小和最大FFR值。
本研究纳入了94例患者的94处病变。ATP-FFR输注时的平均FFR值分别为0.81±0.10，NIC-FFR时为0.80±0.09。ATP-FFR和NIC-FFR总体上具有很强的相关性（r = 0.92，p<0.001）。在18例患者（19%）中，NIC-FFR时的FFR值显著低于ATP-FFR时。在这些患者中的三分之一（6%）中，在NIC-FFR测量后有可能将治疗策略从延迟范围（>0.80）改变为介入范围（≤0.80）。NIC-FFR中FFR的周期性变化小于ATP-FFR（0.03±0.02对0.06±0.05，p<0.0001）。
在日常临床实践中，额外的冠状动脉内尼可地尔可能有助于在静脉注射ATP后确认足够的最大充血状态。此外，冠状动脉内尼可地尔可减少FFR的周期性变化；因此，医生在操作过程中可能更容易确定FFR值。
