Service de cardiologie, clinique Sainte-Clotilde, 127, route du Bois-de-Nèfles, BP 105, 97492 Sainte-Clotilde, France.
Service de cardiologie, clinique Sainte-Clotilde, 127, route du Bois-de-Nèfles, BP 105, 97492 Sainte-Clotilde, France.
Arch Cardiovasc Dis. 2018 Feb;111(2):119-125. doi: 10.1016/j.acvd.2017.04.009. Epub 2017 Nov 8.
Fractional flow reserve (FFR) is defined by the maximal coronary flow ratio with and without stenosis.
We hypothesized that guiding catheter intubation in coronary ostia during FFR measurements may underestimate FFR value by limiting the increase of coronary flow during maximal hyperaemia.
Between June 2013 and January 2014, we prospectively included all patients with i.v. adenosine FFR measurements. FFR was measured with the guiding catheter intubated in the coronary ostia (FFR) and extubated in the aorta (FFR). We calculated the ratio between coronary ostium assessed by quantitative coronary angiography and guiding catheter surfaces, defined as the free ostial lumen ratio.
In total, 151 lesions in 104 patients were included; 121 lesions and 88 patients were eligible for analysis. Mean±SD FFR was significantly lower compared with FFR; 0.82±0.08 and 0.84±0.08, respectively (P<0.001). Revascularization indication changed in 14 patients (16%). The difference induced by guiding extubation correlated significantly with the free ostial lumen ratio (R=0.06, P=0.008).
FFR value is significantly lower when the guiding catheter is extubated. The smaller the coronary ostium, the greater the difference observed between FFR and FFR. Guiding extubation during FFR measurements changed the revascularization indication in 16% of cases.
分比流量储备（FFR）是通过狭窄处和无狭窄处的最大冠状动脉血流比来定义的。
我们假设在进行 FFR 测量时，在冠状动脉口引导导管插管可能会通过限制最大充血期间冠状动脉流量的增加来低估 FFR 值。
在 2013 年 6 月至 2014 年 1 月期间，我们前瞻性地纳入了所有接受静脉内腺苷 FFR 测量的患者。FFR 是通过在冠状动脉口（FFR）插入引导导管和在主动脉（FFR）中拔出导管进行测量的。我们计算了定量冠状动脉造影评估的冠状动脉口与引导导管表面之间的比值，定义为自由口腔比。
共纳入 104 例患者的 151 处病变；121 处病变和 88 例患者符合分析条件。平均±SD 的 FFR 明显低于 FFR；分别为 0.82±0.08 和 0.84±0.08（P<0.001）。有 14 例患者（16%）的血运重建指征发生了变化。引导管拔出引起的差异与自由口腔比显著相关（R=0.06，P=0.008）。
当引导导管拔出时，FFR 值明显降低。冠状动脉口越小，FFR 和 FFR 之间的差异越大。在 FFR 测量过程中引导管拔出改变了 16%患者的血运重建指征。
