Warisawa Takayuki, Howard James P, Kawase Yoshiaki, Tanigaki Toru, Omori Hiroyuki, Cook Christopher M, Ahmad Yousif, Francis Darrel P, Akashi Yoshihiro J, Matsuo Hitoshi, Davies Justin E
Cardiovascular Science, Imperial College London, Hammersmith Hospital, London, United Kingdom; Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan.
Cardiovascular Science, Imperial College London, Hammersmith Hospital, London, United Kingdom.
Int J Cardiol. 2020 Aug 1;312:10-15. doi: 10.1016/j.ijcard.2020.05.001. Epub 2020 May 3.
Identifying the individual hemodynamic significance of tandem coronary artery lesions can be complicated by the crosstalk phenomenon which occurs between serial stenoses under hyperemic conditions. Physiological assessments performed under resting conditions are considered to be, theoretically, less affected by the hemodynamic interaction between serial coronary stenoses. The purpose of this study was to assess whether pressure-wire (PW) pullback measurements at rest and during hyperemia provided different information as to which stenosis appeared to be most functionally significant.
In consecutive patients with angiographically discrete serial lesions, physiological lesion predominance (i.e. proximal or distal) was defined according to the pressure gradient along the vessels on PW-pullback trace. We used instantaneous wave-free ratio (iFR) based assessment as the reference standard and compared fractional flow reserve (FFR) based and hyperemic-iFR based lesion predominance.
Eighty-eight vessels (70 patients, mean age 70.3 ± 9.4 years, 80% male) were included in this study. Median iFR, FFR and hyperemic-iFR were 0.85 (interquartile range [IQR]: 0.74 to 0.91), 0.73 (IQR: 0.65 to 0.80) and 0.60 (IQR: 0.49 to 0.71), respectively. When judged against iFR-pullback based physiological assessment, lesion predominance changed in 22.7% (20/88) in FFR and in 20.5% (18/88) in hyperemic-iFR, respectively. There was no statistical difference between FFR and hyperemic-iFR for the impact on these changes (p = 0.77).
In serial coronary lesions, hyperemic PW-pullback disagreed with resting PW-pullback on the lesion-specific identification of ischemia in approximately 20% of cases, either in whole cardiac cycle or in wave-free period.
由于充血状态下串联狭窄之间会发生串扰现象，确定串联冠状动脉病变的个体血流动力学意义可能会变得复杂。理论上，在静息状态下进行的生理评估受串联冠状动脉狭窄之间血流动力学相互作用的影响较小。本研究的目的是评估静息和充血状态下压力导丝（PW）回撤测量对于确定哪处狭窄在功能上似乎最为显著是否能提供不同信息。
在连续的血管造影显示为离散串联病变的患者中，根据PW回撤轨迹上沿血管的压力梯度定义生理病变优势（即近端或远端）。我们将基于瞬时无波比率（iFR）的评估作为参考标准，并比较基于血流储备分数（FFR）和基于充血状态下iFR的病变优势。
本研究纳入了88条血管（70例患者，平均年龄70.3±9.4岁，80%为男性）。iFR、FFR和充血状态下iFR的中位数分别为0.85（四分位间距[IQR]：0.74至0.91）、0.73（IQR：0.65至0.80）和0.60（IQR：0.49至0.71）。与基于iFR回撤的生理评估相比，FFR中病变优势改变的比例为22.7%（20/88），充血状态下iFR中病变优势改变的比例为20.5%（18/88）。FFR和充血状态下iFR对这些改变的影响无统计学差异（p = 0.77）。
在串联冠状动脉病变中，无论是在整个心动周期还是在无波期，充血状态下的PW回撤在病变特异性缺血识别方面与静息PW回撤不一致的情况约占20%。
