Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia; Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea; Division of Cardiology, Department of Internal Medicine, SoonChunHyang University Bucheon Hospital, Bucheon, Korea.
JACC Cardiovasc Interv. 2017 May 22;10(10):999-1007. doi: 10.1016/j.jcin.2017.03.006.
The aim of this study was to investigate the epicardial and microvascular substrates associated with discordances between fractional flow reserve (FFR) and coronary flow reserve (CFR) values.
Discordances between FFR and CFR remain poorly characterized.
FFR, hyperemic stenosis resistance (HSR), and intravascular ultrasound were performed as indexes of epicardial function and CFR and hyperemic microvascular resistance (HMR) as measures of microvascular function in 94 patients with moderate coronary stenosis. Maximal plaque burden (PB), HSR, and HMR were calculated in 4 quadrants based on values of FFR ≤0.80 and CFR ≤2.0 as follows: concordant normal (preserved FFR and CFR), concordant abnormal (low FFR and CFR), discordant low FFR and preserved CFR, and discordant preserved FFR and low CFR.
Sixty-four patients (68%) had concordant FFR and CFR findings, and 30 patients (32%) had discordant FFR and CFR. Compared with patients with preserved FFR and CFR, those with low FFR and CFR had higher PB (p = 0.003), higher HSR (p < 0.001), and similar HMR. Among patients with preserved FFR, those with reduced CFR had similar PB and HSR but a trend toward higher HMR (p = 0.058) compared with patients with preserved CFR. Among patients with reduced FFR, those with preserved CFR had lower PB (p = 0.004), a trend toward lower HSR (p = 0.065), and lower HMR (p = 0.03) compared with patients with reduced CFR. Furthermore, compared with patients with preserved FFR and low CFR, those with low FFR and preserved CFR had higher HSR (p = 0.022) but lower HMR (p = 0.003).
In patients with moderate coronary stenosis, preserved FFR and low CFR is associated with increased microvascular resistance, while low FFR and preserved CFR has modest epicardial stenosis and preserved microvascular function.
本研究旨在探讨与分数血流储备（FFR）和冠状动脉血流储备（CFR）值不一致相关的心外膜和微血管基础。
FFR 和 CFR 之间的差异仍未得到充分描述。
在 94 例中度冠状动脉狭窄患者中，进行 FFR、充血性狭窄阻力（HSR）和血管内超声检查，以评估心外膜功能，进行 CFR 和充血性微血管阻力（HMR）检查，以评估微血管功能。根据 FFR≤0.80 和 CFR≤2.0 的值，计算最大斑块负担（PB）、HSR 和 HMR 在 4 个象限中的值：一致正常（FFR 和 CFR 正常）、一致异常（FFR 和 CFR 低）、FFR 低和 CFR 正常、FFR 正常和 CFR 低。
64 例患者（68%）FFR 和 CFR 结果一致，30 例患者（32%）FFR 和 CFR 结果不一致。与 FFR 和 CFR 正常的患者相比，FFR 和 CFR 低的患者 PB 更高（p=0.003），HSR 更高（p<0.001），HMR 相似。在 FFR 正常的患者中，与 CFR 正常的患者相比，CFR 降低的患者 PB 和 HSR 相似，但 HMR 有升高趋势（p=0.058）。在 FFR 降低的患者中，与 CFR 降低的患者相比，CFR 正常的患者 PB 更低（p=0.004），HSR 有降低趋势（p=0.065），HMR 更低（p=0.03）。此外，与 FFR 和 CFR 正常的患者相比，FFR 和 CFR 降低的患者 HSR 更高（p=0.022），但 HMR 更低（p=0.003）。
在中度冠状动脉狭窄患者中，FFR 正常和 CFR 降低与微血管阻力增加相关，而 FFR 降低和 CFR 正常则提示心外膜狭窄程度中等，微血管功能正常。
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