Gorla Riccardo, Verna Edoardo, Scotti Simone, Ghiringhelli Sergio, Zoli Laura, Provasoli Stefano, Garancini Silvana, De Ponti Roberto, Salerno-Uriarte Jorge A
aDepartment of Cardiology bDepartment of Nuclear Medicine, Ospedale di Circolo and Fondazione Macchi, University of Insubria, Varese, Italy.
J Cardiovasc Med (Hagerstown). 2017 May;18(5):332-340. doi: 10.2459/JCM.0000000000000490.
To investigate the impact of hyperemic microvascular resistances (HMRs) on myocardial perfusion and contractility after percutaneous coronary intervention (PCI) in chronic ischemic left ventricular dysfunction (CILVD).
The current retrospective study included 48 patients with CILVD of the left anterior descending territory undergoing HMRs assessment before and after PCI with a dual-sensor intracoronary pressure-flow wire. The severity of resting myocardial underperfusion and contractile dysfunction of the left anterior descending territory was scored as summed rest score (SRS-T) by single photon emission tomography, wall motion score index (WMSI-T) and left ventricular ejection fraction (LVEF) by transthoracic echocardiography before PCI and after 3 months. Patients were divided into two groups according to the mean post-PCI HMRs.
Mean post-PCI HMRs were 2.05 ± 0.43 mmHg/cm/s; increased HMRs (i.e. >2 mmHg/cm/s) were found in 17 patients (35.4%, group B) (3.29 ± 0.77 mmHg/cm/s), whereas 31 patients (64.6%, group A) showed lower values (1.35 ± 0.34 mmHg/cm/s; P < 0.001). Pre-PCI HMRs, WMSI-T and SRS-T were similar among groups.After PCI, a significant improvement of LVEF, WMSI-T and SRS-T was observed only in group A (6.6 ± 7.4%, 0.44 ± 0.42 and 3.9 ± 2.9, respectively) compared with group B (1.3 ± 1.9%, 0.02 ± 0.07 and 1.1 ± 1.9; P = 0.011, P < 0.001 and P = 0.028, respectively).Post-PCI HMRs predicted the absence of improvement of LVEF and WMSI-T at a cutoff value of 1.95 mmHg/cm/s (area under the curve 0.69 and 0.73; P = 0.038 and 0.017, respectively), with a positive predictive value of 96 and 100%, respectively.
Increased post-PCI HMRs may predict the lack of functional improvement of the revascularized myocardium in CILVD.
研究慢性缺血性左心室功能障碍（CILVD）患者经皮冠状动脉介入治疗（PCI）后充血性微血管阻力（HMRs）对心肌灌注和收缩功能的影响。
本回顾性研究纳入48例左前降支区域CILVD患者，在PCI前后使用双传感器冠状动脉内压力-血流导丝评估HMRs。PCI前及术后3个月，通过单光子发射断层扫描将左前降支区域静息心肌灌注不足和收缩功能障碍的严重程度记为总静息评分（SRS-T），通过经胸超声心动图评估室壁运动评分指数（WMSI-T）和左心室射血分数（LVEF）。根据PCI后平均HMRs将患者分为两组。
PCI后平均HMRs为2.05±0.43mmHg/cm/s；17例患者（35.4%，B组）HMRs升高（即>2mmHg/cm/s）（3.29±0.77mmHg/cm/s），而31例患者（64.6%，A组）HMRs较低（1.35±0.34mmHg/cm/s；P<0.001）。两组间PCI前HMRs、WMSI-T和SRS-T相似。PCI后，仅A组的LVEF、WMSI-T和SRS-T有显著改善（分别为6.6±7.4%、0.44±0.42和3.9±2.9），而B组分别为1.3±1.9%、0.02±0.07和1.1±1.9（P分别为0.011、<0.001和0.028）。PCI后HMRs预测LVEF和WMSI-T无改善的临界值为1.95mmHg/cm/s（曲线下面积分别为0.69和0.73；P分别为0.038和0.017），阳性预测值分别为96%和100%。
PCI后HMRs升高可能预示CILVD患者血运重建心肌功能改善不佳。
