Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea.
JACC Cardiovasc Interv. 2018 Aug 13;11(15):1423-1433. doi: 10.1016/j.jcin.2018.05.005.
This study investigated the prognostic implication of coronary flow reserve (CFR) in patients who underwent fractional flow reserve (FFR) measurement.
Limited data are available regarding the long-term prognosis associated with thermodilution CFR in patients with coronary artery disease.
A total of 519 patients (737 vessels) who did not undergo revascularization were classified according to FFR and CFR values. Low FFR and low CFR were defined with upper thresholds of 0.8 and 2.0, respectively. FFR and CFR were measured by a pressure-temperature sensor-tipped wire. Clinical outcomes were assessed by the vessel-oriented composite outcome (VOCO) (a composite of cardiac death, vessel-specific myocardial infarction, and vessel-specific revascularization) during 5 years of follow-up.
The categorical agreement (kappa = 0.080; p = 0.024) between FFR and CFR were modest, and 30.6% of the population showed discordant results between FFR and CFR. During 5 years of follow-up, patients with low CFR had a significantly higher risk of VOCO than did those with high CFR (hazard ratio [HR]: 3.171; 95% CI: 1.664 to 6.042; p < 0.001). Among patients with high FFR, there were no differences in clinical risk factor profiles, FFR, or stenosis severity between the high-CFR and low-CFR groups, and low CFR was an independent predictor for VOCO (HR: 4.999; 95% CI: 2.104 to 11.879; p < 0.001). In a 4-group classification according to both FFR and CFR, patients with low FFR and low CFR had the highest risk of VOCO (17.9%; overall p < 0.001).
Patients with low CFR had a significantly higher risk of clinical events during 5 years of follow-up. Low CFR was an independent predictor for patient-oriented composite outcome among patients with high FFR. These results support the value of CFR in patients who undergo FFR measurement. (Clinical, Physical and Prognostic Implication of Microvascular Status; NCT02186093).
本研究旨在探讨经血流储备分数（FFR）测量的患者中，冠状动脉血流储备（CFR）的预后意义。
关于冠状动脉疾病患者热稀释 CFR 相关的长期预后数据有限。
共纳入 519 名（737 支血管）未接受血运重建的患者，根据 FFR 和 CFR 值进行分类。低 FFR 和低 CFR 的定义分别为上限值分别为 0.8 和 2.0。FFR 和 CFR 通过压力-温度传感器尖端导丝测量。在 5 年的随访期间，通过血管导向的复合终点（VOCO）（包括心脏死亡、血管特异性心肌梗死和血管特异性血运重建）评估临床结局。
FFR 和 CFR 的分类一致性（kappa=0.080；p=0.024）中等，人群中有 30.6%的患者 FFR 和 CFR 结果不一致。在 5 年的随访期间，低 CFR 组的 VOCO 风险显著高于高 CFR 组（危险比[HR]：3.171；95%CI：1.664 至 6.042；p<0.001）。在 FFR 高的患者中，高 CFR 和低 CFR 组之间在临床危险因素特征、FFR 或狭窄严重程度方面无差异，低 CFR 是 VOCO 的独立预测因素（HR：4.999；95%CI：2.104 至 11.879；p<0.001）。根据 FFR 和 CFR 进行 4 分组分类后，低 FFR 和低 CFR 的患者 VOCO 风险最高（17.9%；总体 p<0.001）。
在 5 年的随访期间，低 CFR 患者的临床事件风险显著增加。低 CFR 是 FFR 高的患者患者导向复合结局的独立预测因素。这些结果支持在接受 FFR 测量的患者中使用 CFR。（微血管状态的临床、物理和预后意义；NCT02186093）。
