Department of Interventional Cardiology, Papworth Hospital NHS Trust, Cambridge, UK; Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK.
Department of Interventional Cardiology, Papworth Hospital NHS Trust, Cambridge, UK.
Int J Cardiol. 2017 Dec 1;248:92-96. doi: 10.1016/j.ijcard.2017.08.036. Epub 2017 Aug 18.
To assess the relationship between anatomical form and physiological function in atherosclerotic coronary arteries.
Although adverse cardiovascular events are predicted by plaque morphology or invasively-derived hemodynamic indices, the link between these important prognostic measures remains unexplored.
Patients with stable angina underwent fractional flow reserve (FFR), coronary flow reserve (CFR), pressure-derived collateral flow index (CFIp), trans-myocardial biomarker sampling and radiofrequency intravascular ultrasound (IVUS) imaging prior to intervention. Physiological ischemia was defined as either FFR≤0.8 or CFR<2.0.
Mean FFR was 0.70±0.15 and CFR was 2.1±1.3, with 68/92 lesions having FFR≤0.8 and 61/92 having CFR<2.0. On IVUS, FFR≤0.8 lesions had reduced minimal luminal area (MLA, p=0.03), increased plaque burden (PB, p=0.04) and volume (p=0.01). There was no relationship between FFR and IVUS-defined plaque composition. FFR≤0.8 was observed in 75.3%, 72.4% and 70.4% of lesions with MLA≤4mm, PB≥70% and thin-cap fibroatheroma, respectively. Multivariate regression demonstrated FFR≤0.8 was independently predicted by MLA (odds ratio (OR) 0.53, 95% CI 0.29-0.97, p=0.04) and PB (OR 1.10, 95% CI 1.01-1.21, p=0.03). There were no identifiable relationships between plaque structure and CFR or CFIp. CFR<2.0 was associated with whole vessel necrotic core increases (p=0.047), fibrofatty tissue reduction (p=0.004) and elevated baseline transmyocardial high-sensitivity C-reactive protein (hsCRP) gradients (p=0.02).
Measures of plaque structure including PB and MLA are independently associated with FFR, but not with CFR or CFIp. Instead, vessels with low CFR have increased lipid accumulation and a higher transmyocardial hsCRP gradient. These results may explain similarities in clinical outcomes between physiologically and anatomically orientated trials.
评估粥样硬化性冠状动脉解剖形态与生理功能之间的关系。
尽管斑块形态或侵袭性血流动力学指数可预测不良心血管事件，但这些重要预后指标之间的联系仍未得到探索。
稳定型心绞痛患者在介入治疗前接受了血流储备分数（FFR）、冠状动脉血流储备（CFR）、压力衍生侧支血流指数（CFIp）、跨心肌生物标志物取样和射频血管内超声（IVUS）成像检查。生理缺血定义为 FFR≤0.8 或 CFR<2.0。
平均 FFR 为 0.70±0.15，CFR 为 2.1±1.3，68/92 个病变的 FFR≤0.8，61/92 个病变的 CFR<2.0。在 IVUS 上，FFR≤0.8 病变的最小管腔面积（MLA，p=0.03）、斑块负荷（PB，p=0.04）和体积（p=0.01）减少。FFR 与 IVUS 定义的斑块组成之间没有关系。在 MLA≤4mm、PB≥70%和薄帽纤维粥样瘤的病变中，分别有 75.3%、72.4%和 70.4%的病变出现 FFR≤0.8。多变量回归显示，FFR≤0.8 独立预测于 MLA（比值比（OR）0.53，95%置信区间（CI）0.29-0.97，p=0.04）和 PB（OR 1.10，95%CI 1.01-1.21，p=0.03）。斑块结构与 CFR 或 CFIp 之间没有可识别的关系。CFR<2.0 与全血管坏死核心增加（p=0.047）、纤维脂肪组织减少（p=0.004）和升高的基线跨心肌高敏 C 反应蛋白（hsCRP）梯度（p=0.02）相关。
包括 PB 和 MLA 在内的斑块结构测量与 FFR 独立相关，但与 CFR 或 CFIp 无关。相反，CFR 较低的血管中脂质积累增加，跨心肌 hsCRP 梯度升高。这些结果可能解释了生理和解剖定向试验在临床结果上的相似性。
