Johnson Paul M, Madamanchi Chaitanya, Sharalaya Zarina M, Iqbal Zahra, Gehi Anil K, Kaul Prashant, Stouffer George A
Department of Medicine, Division of Cardiology, University of North Carolina, Chapel Hill, North Carolina.
Department of Medicine, Eastern Carolina University, Greenville, North Carolina.
Catheter Cardiovasc Interv. 2017 Feb 1;89(2):226-232. doi: 10.1002/ccd.26635. Epub 2016 Jul 28.
To determine the relationship between severity of stenosis and hemodynamic significance in calcified coronary arteries.
Severity of stenosis is widely used to determine the need for revascularization but the effect of lesion calcification on hemodynamic significance is not well understood.
Two hundred consecutive patients undergoing fractional flow reserve (FFR) testing of an intermediate coronary lesion with a pressure wire and intravenous infusion of adenosine were studied. Coronary calcium was quantified based upon radiopacities at the site of the stenosis on cineangiography using the method of Mintz et al. (0 = none or mild calcium, 1 = moderate calcium, 2 = severe calcium).
Mean age was 61 ± 11 years, 66% were males, 87.5% had hypertension, 44.5% had diabetes, and 20.5% were current smokers. The mean coronary stenosis by quantitative coronary angiography was 60 ± 12% and the mean FFR was 0.83 ± 0.08. There were 109, 45, and 46 patients classified as Calcium Score of 0, 1, or 2, respectively. Compared to those with no/mild or moderate calcification, patients with severe coronary calcium were older and more likely to have chronic kidney disease and pulmonary disease. The correlation between angiographic severity and FFR decreased as lesion calcification increased [calcium score = 0 (R = 0.25, P < 0.005); calcium score = 1 (R = 0.11, P < 0.005); calcium score = 2 (R = 0.02, P = 0.35)].
In patients with heavily calcified coronary lesions, there was no association between angiographic stenosis and hemodynamic significance and FFR is needed to determine hemodynamic significance of intermediate lesions. © 2016 Wiley Periodicals, Inc.
确定钙化冠状动脉狭窄严重程度与血流动力学意义之间的关系。
狭窄严重程度被广泛用于确定血运重建的必要性，但病变钙化对血流动力学意义的影响尚不清楚。
对200例连续接受冠状动脉中间病变血流储备分数（FFR）检测的患者进行研究，使用压力导丝并静脉输注腺苷。采用Mintz等人的方法，根据血管造影时狭窄部位的不透射线程度对冠状动脉钙化进行定量（0 =无或轻度钙化，1 =中度钙化，2 =重度钙化）。
平均年龄为61±11岁，男性占66%，87.5%患有高血压，44.5%患有糖尿病，20.5%为当前吸烟者。定量冠状动脉造影显示平均冠状动脉狭窄为60±12%，平均FFR为0.83±0.08。分别有109、45和46例患者的钙化评分为0、1或2。与无/轻度或中度钙化的患者相比，重度冠状动脉钙化患者年龄更大，更易患慢性肾病和肺病。随着病变钙化增加，血管造影狭窄程度与FFR之间的相关性降低[钙化评分=0（R = 0.25，P < 0.005）；钙化评分=1（R = 0.11，P < 0.005）；钙化评分=2（R = 0.02，P = 0.35）]。
在冠状动脉病变严重钙化的患者中，血管造影狭窄与血流动力学意义之间无关联，需要FFR来确定中间病变的血流动力学意义。©2016威利期刊公司
