Division of Cardiology, Department of Internal Medicine, Yokohama Sakae Kyosai Hospital.
Department of Cardiology, Sagamihara National Hospital.
J Atheroscler Thromb. 2019 Aug 1;26(8):697-704. doi: 10.5551/jat.47621. Epub 2018 Dec 20.
Coronary computed tomography angiography (CCTA)-derived fractional flow reserve (FFR) accurately diagnoses ischemic lesions of intermediate stenosis severity. However, significant determinants of FFR have not been fully evaluated.
This was a sub-analysis of the Treatment of Alogliptin on Coronary Atherosclerosis Evaluated by Computed Tomography-Based Fractional Flow Reserve trial. Thirty-nine diabetic patients (117 vessels) with intermediate coronary artery stenosis [percent diameter stenosis (%DS) ＜70%] in whom FFR was measured were included in this study. CCTA-defined, vessel-based volumetric and morphological characteristics of plaques were examined to determine their ability to predict FFR.
Patient-based, multivariate linear regression analysis showed that hemoglobinA1c, triglycerides, and the estimated glomerular filtration rate were significant independent factors associated with FFR. Vessel-based, univariate linear regression analysis showed that the total atheroma volume (r=－0.233, p=0.01) and the percentage atheroma volume (PAV) (r=－0.284, p=0.002) as well as %DS (r=－0.316, p=0.006) were significant determinants of FFR. Among the plaque components, significant negative correlations were observed between FFR and low- (r=－0.248, p=0.007) or intermediate-attenuation plaque volume (r=－0.186, p=0.045), whereas calcified plaque volume was not associated with FFR. In the left anterior descending coronary artery (LAD), the plaque volume of each component was associated with FFR.
Plaque volume, PAV, and %DS were significant determinants of FFR. Plaque morphology, particularly in LAD, was associated with FFR in diabetic patients with intermediate coronary artery stenosis.
冠状动脉计算机断层扫描血管造影术（CCTA）衍生的血流储备分数（FFR）可准确诊断中度狭窄严重程度的缺血性病变。然而，FFR 的重要决定因素尚未得到充分评估。
这是基于 CT 血流储备分数的阿格列汀治疗冠状动脉粥样硬化的治疗试验的子分析。本研究纳入了 39 例糖尿病患者（117 支血管），这些患者存在中间冠状动脉狭窄（%直径狭窄＜70%），并进行了 FFR 测量。检查 CCTA 定义的基于血管的斑块容积和形态特征，以确定它们预测 FFR 的能力。
基于患者的多元线性回归分析显示，糖化血红蛋白、甘油三酯和估算肾小球滤过率是与 FFR 显著相关的独立因素。基于血管的单变量线性回归分析显示，总粥样斑块体积（r=－0.233，p=0.01）和斑块体积百分比（PAV）（r=－0.284，p=0.002）以及%DS（r=－0.316，p=0.006）是 FFR 的显著决定因素。在斑块成分中，FFR 与低（r=－0.248，p=0.007）或中衰减斑块体积（r=－0.186，p=0.045）呈显著负相关，而钙化斑块体积与 FFR 无关。在前降支（LAD）中，每个斑块成分的斑块体积均与 FFR 相关。
斑块体积、PAV 和%DS 是 FFR 的显著决定因素。斑块形态，特别是在 LAD 中，与糖尿病患者中间冠状动脉狭窄的 FFR 相关。
