Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan (Y. Kanaji, T.Y., R.H., T.M., E.U., M. Hoshino, M.Y., M. Hada, Y. Kanno, T.F., H.O., Y.S., A.S., T.L., T.K.).
Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan (K.H.).
Circ Cardiovasc Interv. 2018 Jul;11(7):e006676. doi: 10.1161/CIRCINTERVENTIONS.118.006676.
Few studies have documented changes in global absolute coronary blood flow and global coronary flow reserve after percutaneous coronary intervention (PCI) in relation to regional physiological measures. Phase-contrast cine-magnetic resonance of the coronary sinus is a promising approach to quantify global absolute coronary blood flow. We aimed to assess the impact of elective PCI on global absolute coronary blood flow and global coronary flow reserve by quantifying coronary sinus flow (CSF) using phase-contrast cine-magnetic resonance in relation to regional physiological indices.
We prospectively studied 54 patients with stable angina undergoing elective PCI for a single proximal lesion. Phase-contrast cine-magnetic resonance was used to assess CSF and CSF reserve at rest and during maximum hyperemia, before and after PCI. Regional physiological indices were obtained during PCI. A complete data set was obtained in 50 patients. Hyperemic CSF increased significantly after PCI (pre-PCI, 230.2 [167.4-282.8] mL/min; post-PCI, 267.4 [224.1-346.2] mL/min; <0.01), although 12 patients (24.0%) showed a decrease, despite successful PCI and improved fractional flow reserve. CSF reserve numerically, albeit not statistically significant (=0.19), increased from 2.65 (1.95-3.96) to 2.98 (2.13-4.32). Patients with decreased CSF after PCI were associated with significantly greater pre-PCI hyperemic CSF, lower global coronary vascular resistance, lower regional microcirculatory resistance, and higher fractional flow reserve (all <0.01).
Fractional flow reserve-guided PCI in patients with single de novo lesions was associated with increased absolute hyperemic CSF, although 24% of patients showed decreased hyperemic CSF, despite successful and uncomplicated PCI. The present approach combining regional and global physiological assessments may provide a novel insight into the dynamic behavior of the coronary hemodynamics and microvascular function after PCI.
很少有研究记录经皮冠状动脉介入治疗（PCI）后与区域生理指标相关的全球绝对冠状动脉血流和全球冠状动脉血流储备的变化。冠状动脉窦的相位对比电影磁共振是一种有前途的定量测量全球绝对冠状动脉血流的方法。我们旨在通过使用相位对比电影磁共振定量冠状动脉窦血流（CSF），评估选择性 PCI 对全球绝对冠状动脉血流和全球冠状动脉血流储备的影响，同时评估与区域生理指数的关系。
我们前瞻性研究了 54 例因单一近端病变而行选择性 PCI 的稳定型心绞痛患者。使用相位对比电影磁共振在 PCI 前后评估静息和最大充血时的 CSF 和 CSF 储备。在 PCI 期间获得区域生理指数。50 例患者获得完整数据集。PCI 后，充血性 CSF 显著增加（PCI 前：230.2[167.4-282.8]mL/min；PCI 后：267.4[224.1-346.2]mL/min；<0.01），尽管 12 例患者（24.0%）尽管 PCI 成功且血流储备分数改善，但仍出现下降。CSF 储备从 2.65（1.95-3.96）增加到 2.98（2.13-4.32），尽管无统计学意义（=0.19）。PCI 后 CSF 降低的患者与 PCI 前充血性 CSF 显著升高、较低的冠状动脉总血管阻力、较低的区域微循环阻力和较高的血流储备分数（均<0.01）相关。
在单发性新发病变患者中，基于血流储备分数的 PCI 与绝对充血性 CSF 增加相关，尽管 24%的患者尽管 PCI 成功且无并发症，但仍显示充血性 CSF 降低。这种结合区域和全球生理评估的方法可能为 PCI 后冠状动脉血流动力学和微血管功能的动态行为提供新的见解。
