不同舒张期静息指数与 iFR 的比较：它们都一样吗？
Comparison of Different Diastolic Resting Indexes to iFR: Are They All Equal?
机构信息
Department of Cardiology, Catharina Hospital Eindhoven, Eindhoven, the Netherlands; Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.
Department of Cardiology, Catharina Hospital Eindhoven, Eindhoven, the Netherlands; Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.
出版信息
J Am Coll Cardiol. 2017 Dec 26;70(25):3088-3096. doi: 10.1016/j.jacc.2017.10.066.
BACKGROUND
Pressure measurement for the duration of the wave-free period (WFP) is considered essential for resting-state physiological assessment of coronary stenosis severity using the instantaneous wave-free ratio (iFR).
OBJECTIVES
The aim of this study was to compare other diastolic resting indexes to iFR.
METHODS
In the population of the VERIFY2 (Pd/Pa vs iFR in an Unselected Population Referred for Invasive Angiography) study, iFR calculated by proprietary software (Volcano Harvest, Volcano Corporation, Rancho Cordova, California) was compared with the ratio of resting distal coronary pressure and aortic pressure during the complete duration of diastole (dPR), 25% to 75% of diastole (dPR), and midpoint of diastole (dPR), along with Matlab calculated iFR (iFR) and iFR-like indexes shortening the length of the WFP by 50 and 100 ms (iFR and iFR), respectively. Mutual differences, Spearman correlations, area under the curve values from receiver-operating characteristic analyses, and diagnostic performance with respect to iFR and fractional flow reserve (FFR) were calculated for all indexes.
RESULTS
Median iFR in 197 patients with 257 vessels was 0.91 with an interquartile range of 0.87 to 0.95. The mutual differences (± SD) with iFR were 0.006 ± 0.011 (dPR), 0.001 ± 0.007 (dPR), 0.001 ± 0.008 (dPR), 0.005 ± 0.009 (iFR), 0.003 ± 0.008 (iFR), and 0.001 ± 0.009 (iFR). Correlations for all indexes with iFR were >0.99 (p < 0.001 for all). Area under the curve values for predicting iFR were >0.99 for all indexes as well. Diagnostic accuracy compared with FFR was 76% to 77% for all indexes including iFR.
CONCLUSIONS
All diastolic resting indexes tested were identical to iFR, both numerically and with respect to their agreement with FFR. A numerically equal value to iFR can be determined without restriction to the WFP. Cutoff values, guidelines, and clinical recommendations for iFR can therefore be extended to these other indexes. (Pd/Pa vs iFR in an Unselected Population Referred for Invasive Angiography [VERIFY2]; NCT02377310).
背景
使用瞬时无波比（iFR）评估冠状动脉狭窄严重程度的静息状态生理时，需要测量整个无波间期（WFP）的压力。
目的
本研究旨在比较其他舒张期静息指标与 iFR。
方法
在 VERIFY2 研究（未经选择行血管造影术患者的 Pd/Pa 与 iFR 对比）的人群中，通过专有的软件（Volcano Harvest，Volcano Corporation，Rancho Cordova，加利福尼亚州）计算 iFR，并与舒张期全程（dPR）、舒张期 25%至 75%（dPR）和舒张期中点（dPR）时远端冠状动脉压与主动脉压的比值进行比较，同时比较使用 Matlab 计算的 iFR（iFR）以及通过缩短 WFP 长度 50 和 100ms 得到的 iFR-like 指数（iFR 和 iFR）。计算所有指标的相互差值、Spearman 相关系数、受试者工作特征分析曲线下面积值以及相对于 iFR 和血流储备分数（FFR）的诊断性能。
结果
197 例 257 支血管患者的中位 iFR 为 0.91，四分位距为 0.87 至 0.95。与 iFR 的相互差值（±SD）分别为 0.006±0.011（dPR）、0.001±0.007（dPR）、0.001±0.008（dPR）、0.005±0.009（iFR）、0.003±0.008（iFR）和 0.001±0.009（iFR）。所有指标与 iFR 的相关性均>0.99（p<0.001）。所有指标预测 iFR 的曲线下面积值均>0.99。与 FFR 相比，所有指标的诊断准确性均为 76%至 77%，包括 iFR。
结论
所有测试的舒张期静息指标在数值上与 iFR 完全一致，与 FFR 的一致性也一致。可在不受 WFP 限制的情况下确定与 iFR 相等的数值。因此，可将 iFR 的截断值、指南和临床建议扩展到这些其他指标。（Pd/Pa 与 iFR 对比：未经选择行血管造影术患者的研究[VERIFY2]；NCT02377310）
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