Yokota Shu, Borren Nanette M, Ottervanger Jan Paul, Mouden Mohamed, Timmer Jorik R, Knollema Siert, Jager Pieter L
Department of Cardiology, Isala Hospital, Dr. Van Heesweg 2, 8025 AB, Zwolle, The Netherlands.
Department of Nuclear Medicine, Isala Hospital, Zwolle, The Netherlands.
J Nucl Cardiol. 2020 Aug;27(4):1306-1313. doi: 10.1007/s12350-019-01712-0. Epub 2019 May 1.
Fractional Flow Reserve (FFR) is increasingly used to estimate the severity of coronary stenoses, prior to coronary revascularization. However, it has been suggested that FFR overestimates the severity of Left Anterior Descending (LAD) lesions. Our aim was to verify whether in patients without ischemia on Myocardial Perfusion Imaging, FFR of the LAD is more often abnormal in comparison to FFR of other coronary arteries.
Prospective cohort study of consecutive patients who underwent FFR measurement because of persistent or worsening of angina complaints, within 6 months after normal Myocardial Perfusion Imaging. FFR measurements of a graft or diagonal branch were excluded. A FFR ≤ 0.80 denoted a functionally relevant stenosis.
In 133 patients, 167 FFR measurements were performed, of which 85 in the LAD. Mean age of the patients was 64.8 ± 10.5 years, 40% were women. There were no differences in baseline characteristics between patients undergoing LAD and non-LAD measurements. An abnormal FFR was observed in 35.3% of the LAD measurements, compared to 9.8% in the non-LAD measurements (P = 0.001). Also after adjusting for age and gender, the FFR remained more frequently abnormal in the LAD with OR 5.2 (95% CI 2.2 to 12.3). Of the abnormal FFR LAD measurements, 70% were visually considered non-obstructive on invasive angiography.
In selected patients without ischemia on MPI, FFR measurement of the LAD is significantly more often abnormal. The majority of these patients has no obstructive lesions on invasive angiography. Possibly, FFR overestimates severity of LAD lesions, with risk of unnecessary revascularization.
在冠状动脉血运重建术前，血流储备分数（FFR）越来越多地用于评估冠状动脉狭窄的严重程度。然而，有人提出FFR高估了左前降支（LAD）病变的严重程度。我们的目的是验证在心肌灌注成像无缺血的患者中，与其他冠状动脉的FFR相比，LAD的FFR是否更常出现异常。
对因心绞痛症状持续或加重而在心肌灌注成像正常后6个月内接受FFR测量的连续患者进行前瞻性队列研究。排除移植血管或对角支的FFR测量。FFR≤0.80表示存在功能相关狭窄。
133例患者共进行了167次FFR测量，其中85次测量LAD。患者的平均年龄为64.8±10.5岁，40%为女性。进行LAD测量和非LAD测量的患者在基线特征上无差异。LAD测量中35.3%观察到FFR异常，而非LAD测量中这一比例为9.8%（P = 0.001）。在调整年龄和性别后，LAD的FFR仍更频繁地出现异常，比值比为5.2（95%可信区间2.2至12.3）。在FFR异常的LAD测量中，70%在有创血管造影中肉眼观察为非阻塞性病变。
在MPI无缺血的特定患者中，LAD的FFR测量明显更常出现异常。这些患者中的大多数在有创血管造影中无阻塞性病变。FFR可能高估了LAD病变的严重程度，存在不必要血运重建的风险。
