Department of Cardiology, Amsterdam Cardiovascular Sciences, VU University Medical Center, De Boelelaan 1117, HV Amsterdam, The Netherlands.
National Heart and Lung Institute, 2nd Floor B Block, Hammersmith Hospital, Imperial College London, UK.
Eur Heart J. 2018 Dec 7;39(46):4072-4081. doi: 10.1093/eurheartj/ehy632.
Guidelines recommend the use of fractional flow reserve (FFR) to guide percutaneous coronary intervention. For this purpose, physiological lesion assessment without adenosine may have a similar diagnostic accuracy as FFR. We aimed to investigate the performances of FFR, resting instantaneous wave-free ratio (iFR), and resting Pd/Pa compared with [15O]H2O positron emission tomography (PET) perfusion imaging.
[15O]H2O PET and intracoronary pressure measurements were evaluated in 320 coronary arteries (of which 136 coronary stenoses) in 129 stable patients. The primary analysis consisting of the area-under-the-receiver-operating-characteristic curve for impaired PET hyperaemic myocardial blood flow (MBF) <2.3 mL⋅min-1⋅g-1 in coronary stenoses was 0.78 [95% confidence interval (CI): 0.70-0.85] for FFR, 0.74 (95% CI: 0.66-0.81) for iFR, and 0.75 (95% CI: 0.67-0.82) for Pd/Pa. No significant differences between area-under-the-receiver-operating-characteristic curve were observed for any two indices compared. In a secondary analysis, the diagnostic accuracy compared with impaired PET hyperaemic MBF in coronary stenoses was 72% (95% CI: 64-79%, κ: 0.44) for FFR ≤0.80, 72% (95% CI: 64-80%, κ: 0.44) for iFR ≤0.89, and 70% (95% CI: 62-78%, κ: 0.40) for Pd/Pa ≤0.92. Other secondary analyses included a comparison of physiological indices with PET hyperaemic MBF in all vessels and all of the aforementioned analyses using PET myocardial perfusion reserve as comparator. Statistical testing for the secondary analyses showed results that were consistent with the results of the primary analysis.
Fractional flow reserve, iFR, and Pd/Pa showed a similar performance when compared with PET imaging. Our results support the validity of invasive physiological lesion assessment under resting conditions by iFR or Pd/Pa.
Sub-study of the PACIFIC trial with clinicaltrials.gov identifier: NCT01521468.
指南建议使用血流储备分数（FFR）来指导经皮冠状动脉介入治疗。为此，无腺苷的生理病变评估可能具有与 FFR 相似的诊断准确性。我们旨在研究 FFR、静息瞬时无波比（iFR）和静息 Pd/Pa 与 [15O]H2O 正电子发射断层扫描（PET）灌注成像的性能比较。
在 129 例稳定型患者的 320 条冠状动脉（其中 136 条冠状动脉狭窄）中评估了 [15O]H2O PET 和冠状动脉内压力测量值。主要分析包括冠状动脉狭窄部位 PET 灌注成像显示的充血性心肌血流（MBF）<2.3 mL·min-1·g-1 的受者操作特征曲线下面积，FFR 为 0.78（95%可信区间：0.70-0.85），iFR 为 0.74（95%可信区间：0.66-0.81），Pd/Pa 为 0.75（95%可信区间：0.67-0.82）。任何两个指标之间的曲线下面积差异均无统计学意义。在次要分析中，与冠状动脉狭窄部位 PET 充血性 MBF 相比，FFR≤0.80 的诊断准确性为 72%（95%可信区间：64-79%，κ：0.44），iFR≤0.89 的诊断准确性为 72%（95%可信区间：64-80%，κ：0.44），Pd/Pa≤0.92 的诊断准确性为 70%（95%可信区间：62-78%，κ：0.40）。其他次要分析包括比较所有血管和上述所有分析中生理指标与 PET 充血性 MBF 的相关性。对次要分析的统计学检验结果与主要分析结果一致。
FFR、iFR 和 Pd/Pa 与 PET 成像比较时表现相似。我们的结果支持 iFR 或 Pd/Pa 用于静息状态下有创生理病变评估的有效性。
PACIFIC 试验的亚研究，临床试验.gov 标识符：NCT01521468。
