Cardiovascular Research Center Aalst, Aalst, Belgium.
EuroIntervention. 2018 Oct 20;14(8):907-914. doi: 10.4244/EIJ-D-17-00872.
The aim of this study was to explore the evolution of coronary lesions which had repeated physiologic evaluation by FFR as an endpoint, describe the clinical significance of longitudinal FFR change (ΔFFR=FFRfollow-up-FFRbaseline) and its correlation with angiographic indices, and identify predictors of FFRfollow-up.
A retrospective, single-centre analysis of 414 stenoses (331 patients) with consecutive FFR measurements at least six months apart was performed (median time interval: 24 [17, 37] months). The change in percent diameter stenosis was 2% (-5%, 11%). FFR values at baseline and follow-up were 0.86 (0.82, 0.90) and 0.83 (0.79, 0.90), respectively (<0.0001). The median ΔFFR was -0.007 (-0.028, 0.010) per year. Worsening FFR (ΔFFR <-0.05) was observed in 105 (25%) stenoses, stable FFR (-0.05 ≤ΔFFR ≤0.05) in 276 (67%) and improving FFR (ΔFFR >0.05) in 33 (8%) stenoses. The number of haemodynamically significant stenoses (FFR ≤0.80) was higher at follow-up compared to baseline (33% versus 17%, p<0.0001); ΔFFR correlated weakly with delta diameter stenosis (Δ%DS, ρ=-0.111, p=0.024). In mixed effects repeated measures analysis, only lesion location had an independent correlation with FFR values after adjusting for multiple confounders. In ROC analysis, FFRbaseline values predicted future clinically significant values (c-statistic: 0.736 [95% CI: 0.682-0.783]).
FFR values decrease slowly over a two-year follow-up. FFRbaseline, but not angiographic indices, is a predictor of significant functional atherosclerosis progression, predicting which stenoses will require revascularisation.
本研究旨在探讨以重复血流储备分数（FFR）评估作为终点的冠状动脉病变的演变，描述纵向 FFR 变化（ΔFFR=FFR 随访-FFR 基线）的临床意义及其与血管造影指数的相关性，并确定 FFR 随访的预测因素。
对至少相隔 6 个月的 414 处狭窄（331 例患者）进行了回顾性、单中心分析（中位时间间隔：24 [17，37] 个月）。直径狭窄百分比的变化为 2%（-5%，11%）。基线和随访时的 FFR 值分别为 0.86（0.82，0.90）和 0.83（0.79，0.90）（<0.0001）。每年的中位 ΔFFR 为-0.007（-0.028，0.010）。105 处狭窄（25%）的 FFR 恶化（ΔFFR <-0.05），276 处狭窄（67%）的 FFR 稳定（-0.05 ≤ΔFFR ≤0.05），33 处狭窄（8%）的 FFR 改善（ΔFFR >0.05）。与基线相比，随访时血流动力学意义重大的狭窄（FFR ≤0.80）数量更高（33%对 17%，p<0.0001）；ΔFFR 与 Δ%DS 呈弱相关（ρ=-0.111，p=0.024）。在混合效应重复测量分析中，在校正了多个混杂因素后，只有病变位置与 FFR 值具有独立相关性。在 ROC 分析中，FFR 基线值可预测未来有临床意义的狭窄（C 统计量：0.736[95%CI：0.682-0.783]）。
FFR 值在两年的随访中缓慢下降。FFR 基线值，但不是血管造影指数，是预测功能性动脉粥样硬化进展的指标，可预测哪些狭窄需要血运重建。
