Costantini Costantino Roberto Frack, Ramires Jose Antonio, Costantini Costantino Ortiz, Denk Marcos Antonio, Tarbine Sergio Gustavo, Santos Marcelo de Freitas, Zanuttini Daniel Aníbal, Silveira Carmen Weigert, Souza Admar Moraes de, Macedo Rafael Michel de
Hospital Cardiológico Costantini, Curitiba, PR, Brazil.
Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
Arq Bras Cardiol. 2017 Jan;108(1):38-46. doi: 10.5935/abc.20160184. Epub 2016 Dec 8.
Functional assessment of coronary artery obstruction is used in cardiology practice to correlate anatomic obstructions with flow decrease. Among such assessments, the study of the coronary fractional flow reserve (FFR) has become the most widely used.
To evaluate the correlation between FFR and findings of ischemia obtained by noninvasive methods including stress echocardiography and nuclear medicine and the presence of critical coronary artery obstruction.
Retrospective study of cases treated with systematized and standardized procedures for coronary disease between March 2011 and August 2014. We included 96 patients with 107 critical coronary obstructions (> 50% in the coronary trunk and/or ≥ 70% in other segments) estimated by quantitative coronary angiography (QCA) and intracoronary ultrasound (ICUS). All cases presented ischemia in one of the noninvasive studies.
All 96 patients presented ischemia (100%) in one of the functional tests. On FFR study with adenosine 140 g/kg/min, 52% of the cases had values ≤ 0.80. On correlation analysis for FFR ≤ 0.80, the evaluation of sensitivity, specificity, positive and negative predictive values, accuracy, and ROC curve in relation to the stenosis degree and length, and presence of ischemia, no significant values or strong correlation were observed.
Coronary FFR using a cut-off value of 0.80 showed no correlation with noninvasive ischemia tests in patients with severe coronary artery obstructions on QCA and ICUS.
在心脏病学实践中，冠状动脉阻塞的功能评估用于将解剖学阻塞与血流减少相关联。在这些评估中，冠状动脉血流储备分数（FFR）的研究已成为使用最广泛的。
评估FFR与通过包括负荷超声心动图和核医学在内的非侵入性方法获得的缺血结果以及严重冠状动脉阻塞的存在之间的相关性。
对2011年3月至2014年8月间采用系统化和标准化程序治疗的冠心病病例进行回顾性研究。我们纳入了96例患者，通过定量冠状动脉造影（QCA）和冠状动脉内超声（ICUS）评估出107处严重冠状动脉阻塞（冠状动脉主干>50%和/或其他节段≥70%）。所有病例在一项非侵入性研究中均表现出缺血。
所有96例患者在一项功能测试中均表现出缺血（100%）。在以140μg/kg/min的腺苷进行FFR研究时，52%的病例值≤0.80。在对FFR≤0.80进行相关性分析时，未观察到与狭窄程度、长度以及缺血存在相关的敏感性、特异性、阳性和阴性预测值、准确性及ROC曲线的显著值或强相关性。
对于QCA和ICUS显示存在严重冠状动脉阻塞的患者，使用截断值0.80的冠状动脉FFR与非侵入性缺血测试无相关性。
