Di Gioia Giuseppe, Scarsini Roberto, Strisciuglio Teresa, De Biase Chiara, Zivelonghi Carlo, Franco Danilo, De Bruyne Bernard, Ribichini Flavio, Barbato Emanuele
Department of Cardiology, Cardiovascular Research Center Aalst, Onze Lieve Vrouw (OLV) Hospital, Aalst, Belgium; Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy.
Division of Cardiology, Department of Medicine, School of Medicine, University of Verona, Verona, Italy.
Am J Cardiol. 2017 Jul 1;120(1):106-110. doi: 10.1016/j.amjcard.2017.03.250. Epub 2017 Apr 12.
We aimed to assess the correlation between angiographic and physiologic evaluation of coronary lesions in aortic stenosis (AS) patients presenting with intermediate coronary stenoses at the angiography. From 2002 to 2010, we included 163 patients from 2 centers with both AS and coronary artery disease (CAD), matched by age and gender with 163 contemporary patients with CAD alone. With both quantitative coronary angiography and fractional flow reserve (FFR), we assessed 259 coronary stenoses in the AS + CAD group, and 256 in the CAD alone group. A significant correlation was found between diameter stenosis (DS) and FFR in both groups, although this was significantly stronger in the AS + CAD than in the CAD alone group (R = -0.63 vs -0.44, p <0.01). Likewise, the correlation between minimum lumen diameter and FFR was stronger in the AS + CAD than in the CAD alone group (R = -0.54 vs -0.41, p = 0.05). Receiver operator characteristic curves analysis showed that DS was a better predictor of hemodynamically significant coronary stenoses (FFR ≤0.8) in the AS + CAD rather than in the CAD alone group (area under the curve = 0.83 vs 0.67, p <0.01). With 50% DS cut-off value, the sensitivity, specificity, and accuracy was 77%, 66%, and 70% in the AS + CAD group versus 59%, 63%, and 61% in the CAD alone group. In both groups, the diagnostic accuracy of DS in predicting FFR was higher in the right and circumflex coronary artery compared with the left anterior descending artery (LAD), although this was only statistically significant in the AS + CAD group (area under the curve 0.88 in the right and circumflex coronary artery vs 0.76 in LAD, p = 0.03). In conclusion, the correlation between the angiographic and hemodynamic significance of coronary stenoses is modest in AS patients. The assessment of CAD severity solely based on angiography poorly predicts the hemodynamic significance of the coronary stenosis especially when these are located in the LAD.
我们旨在评估血管造影与生理学评估之间的相关性，这些评估针对的是在血管造影中呈现中度冠状动脉狭窄的主动脉瓣狭窄（AS）患者的冠状动脉病变。从2002年到2010年，我们纳入了来自2个中心的163例同时患有AS和冠状动脉疾病（CAD）的患者，并按年龄和性别与163例当代单纯CAD患者进行匹配。通过定量冠状动脉造影和血流储备分数（FFR），我们评估了AS + CAD组中的259处冠状动脉狭窄，以及单纯CAD组中的256处。两组中均发现直径狭窄（DS）与FFR之间存在显著相关性，尽管在AS + CAD组中这种相关性比单纯CAD组更强（R = -0.63对-0.44，p <0.01）。同样，AS + CAD组中最小管腔直径与FFR之间的相关性比单纯CAD组更强（R = -0.54对-0.41，p = 0.05）。受试者工作特征曲线分析表明，DS在AS + CAD组中比在单纯CAD组中是血流动力学显著冠状动脉狭窄（FFR≤0.8）的更好预测指标（曲线下面积 = 0.83对0.67，p <0.01）。以50%的DS截断值，AS + CAD组的敏感性、特异性和准确性分别为77%、66%和70%，而单纯CAD组分别为59%、63%和61%。在两组中，与左前降支（LAD）相比，DS在预测FFR方面在右冠状动脉和回旋支中的诊断准确性更高，尽管这仅在AS + CAD组中具有统计学意义（右冠状动脉和回旋支的曲线下面积为0.88，而LAD为0.76，p = 0.03）。总之，在AS患者中，冠状动脉狭窄的血管造影与血流动力学意义之间的相关性一般。仅基于血管造影对CAD严重程度的评估很难预测冠状动脉狭窄的血流动力学意义，尤其是当这些狭窄位于LAD时。
