Zimmermann Frederik M, Pijls Nico H J, De Bruyne Bernard, Bech G Jan-Willem, van Schaardenburgh Pepijn, Kirkeeide Richard L, Gould K Lance, Johnson Nils P
Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands.
Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.
Catheter Cardiovasc Interv. 2017 Nov 15;90(6):917-925. doi: 10.1002/ccd.26972. Epub 2017 Mar 15.
We propose a novel technique called pressure-bounded coronary flow reserve (pb-CFR) and demonstrate its application to the randomized DEFER trial.
Intracoronary flow reserve assessment remains underutilized relative to pressure measurements partly due to less robust tools.
While rest and hyperemic intracoronary pressure measurements cannot quantify CFR exactly, they do provide upper and lower bounds. We validated pb-CFR invasively against traditional CFR, then applied it to high fractional flow reserve (FFR ≥ 0.75) lesions in DEFER randomized to revascularization or medical therapy.
pb-CFR showed an 84.4% accuracy to predict invasive CFR < 2 or CFR ≥ 2 in 107 lesions. In its proof of concept application to DEFER lesions with FFR ≥ 0.75, the 28 with pb-CFR < 2 compared to 28 with pb-CFR ≥ 2 had a non-significant reduction in freedom from angina (61% vs. 71% at 5 years, P = 0.57) and a non-significantly higher rate of major adverse cardiac events (MACE, 25% vs. 15%, P = 0.34). Lesions with FFR ≥ 0.75 but pb-CFR < 2 showed no difference in freedom from angina (61% vs. 50%, P = 0.54) or MACE (25% vs. 38%, P = 0.27) between the 28 randomized to medical therapy and the 16 randomized to revascularization.
pb-CFR offers a new method for studying FFR/CFR discordances using regular pressure wire measurements. As an example application, DEFER suggested that low pb-CFR with high FFR may be a risk marker for more angina and worse outcomes, but that this risk cannot be modified by revascularization. © 2017 Wiley Periodicals, Inc.
我们提出一种名为压力限定冠状动脉血流储备（pb-CFR）的新技术，并展示其在随机化DEFER试验中的应用。
相对于压力测量，冠状动脉内血流储备评估的应用仍然不足，部分原因是工具不够强大。
虽然静息和充血状态下的冠状动脉内压力测量不能精确量化CFR，但它们确实提供了上下限。我们通过传统CFR对pb-CFR进行了有创验证，然后将其应用于DEFER试验中随机分配接受血运重建或药物治疗的高分数血流储备（FFR≥0.75）病变。
在107个病变中，pb-CFR预测有创CFR<2或CFR≥2的准确率为84.4%。在其对FFR≥0.75的DEFER病变的概念验证应用中，与pb-CFR≥2的28个病变相比，pb-CFR<2的28个病变在无心绞痛方面的降低无统计学意义（5年时分别为61%和71%，P=0.57），主要不良心脏事件（MACE）发生率无显著升高（25%对15%，P=0.34）。随机接受药物治疗的28个病变与随机接受血运重建的16个病变相比，FFR≥0.75但pb-CFR<2的病变在无心绞痛方面（61%对50%，P=0.54）或MACE方面（25%对38%，P=0.27）无差异。
pb-CFR提供了一种使用常规压力导丝测量研究FFR/CFR不一致性的新方法。作为一个示例应用，DEFER表明高FFR伴低pb-CFR可能是更多心绞痛和更差预后的风险标志物，但这种风险不能通过血运重建来改善。©2017威利期刊公司。
