Karamasis Grigoris V, Kalogeropoulos Andreas S, Mohdnazri Shah H, Al-Janabi Firas, Jagathesan Rohan, Clesham Gerald J, Tang Kare H, Kelly Paul A, Davies John R, Keeble Thomas R
Department of Cardiology, Essex Cardiothoracic Centre, Basildon, United Kingdom; Postgraduate Medical Institute, Anglia Ruskin University, Cambridge & Chelmsford, UK.
Department of Cardiology, Royal Sussex County Hospital, Brighton, United Kingdom.
Cardiovasc Revasc Med. 2018 Sep;19(6):679-684. doi: 10.1016/j.carrev.2018.02.001. Epub 2018 Feb 7.
The aim of this study was to assess the impact of right atrial pressure (Pra) on non-CTO vessels FFR measurements in patients with a chronic total occlusion.
Consecutive patients who underwent PCI for a CTO of the right coronary artery (RCA) were included. Prior to RCA recanalization, FFR and FFR were measured in non-CTO vessels. FFR was calculated using the Pd/Pa equation during maximum hyperaemia and also accounting for right atrial pressure (Pd-Pra/Pa-Pra). Non-CTO vessels were characterised as major or minor donors based on angiographic assessment of provided collaterals.
FFR and FFR were measured in 68 arteries (34 LAD and 34 Cx) in 34 consecutive patients with successful RCA CTO PCI. Patients' mean age was 62 ± 10 years old and 88% were male. Mean left ventricular ejection fraction was 51% ± 20. During maximum hyperaemia, mean Pra, Pa, and Pd were 4.1 ± 3.8 mm Hg, 82.6 ± 12.2 mm Hg, and 63.8 ± 14.3 mm Hg, respectively. In the major donor vessel, FFR showed a difference of 0.007 to FFR (0.760 ± 0.113 vs. 0.767 ± 0.112, p = 0.004). In the minor donor vessel the difference was 0.004 (0.895 ± 0.067 vs. 0.899 ± 0.065, p < 0.001). There was a strong positive correlation between the FFR and FFRmyo in both the major and minor donor vessel groups (r = 0.993, p < 0.001 and r = 0.996, p < 0.001 respectively).
In the presence of a CTO, RA pressure adjustment of FFR in the non-CTO vessels leads to trivial numerical changes, which are statistically significant but clinically negligible.
本研究的目的是评估右心房压力（Pra）对慢性完全闭塞患者非慢性完全闭塞（CTO）血管血流储备分数（FFR）测量值的影响。
纳入连续接受右冠状动脉（RCA）慢性完全闭塞病变经皮冠状动脉介入治疗（PCI）的患者。在RCA再通之前，测量非CTO血管的FFR和校正FFR。FFR在最大充血期间使用Pd/Pa公式计算，并考虑右心房压力（Pd - Pra/Pa - Pra）。根据提供的侧支血管造影评估，将非CTO血管分为主要供血血管或次要供血血管。
在34例成功进行RCA慢性完全闭塞病变PCI的连续患者中，对68条动脉（34条左前降支动脉和34条回旋支动脉）测量了FFR和校正FFR。患者的平均年龄为62±10岁，88%为男性。平均左心室射血分数为51%±20。在最大充血期间，平均Pra、Pa和Pd分别为4.1±3.8 mmHg、82.6±12.2 mmHg和63.8±14.3 mmHg。在主要供血血管中，校正FFR与FFR相比差异为0.007（0.760±0.113对0.767±0.112，p = 0.004）。在次要供血血管中，差异为0.004（0.895±0.067对0.899±0.065，p < 0.001）。在主要和次要供血血管组中，校正FFR与心肌FFR之间均存在强正相关（分别为r = 0.993，p < 0.001和r = 0.996，p < 0.001）。
在存在慢性完全闭塞病变的情况下，对非慢性完全闭塞血管的FFR进行右心房压力校正会导致数值上的微小变化，这些变化在统计学上具有显著性，但在临床上可忽略不计。
