Division of Cardiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
III. Department of Internal Medicine, Szabolcs-Szatmár-Bereg County Hospitals and University Teaching Hospital, 68. Szent István Street, Nyíregyháza, 4400, Hungary.
Int J Cardiovasc Imaging. 2021 Jan;37(1):5-14. doi: 10.1007/s10554-020-01971-w. Epub 2020 Aug 17.
The effect of hydrostatic pressure on physiological intracoronary measurements is usually ignored in the daily clinical practice. Our aim was to investigate this effect on Pd/Pa (distal/aortic pressure) and FFR (fractional flow reserve). 41 FFR measurements between 0.7 and 0.9 were selected. The difference in the height of the orifice and that of the sensor was defined in mm on the basis of 3D coronary reconstruction. Resting Pd/Pa and FFR were adjusted by subtracting the hydrostatic pressure gradient from the distal pressure. Height measurements were also performed from 2D lateral projections for each coronary segment (n = 305). In case of the LAD, each segment was located higher (proximal: - 13.69 ± 5.4; mid: - 46.13 ± 6.1; distal: - 56.80 ± 7.7 mm), whereas for the CX, each segment was lower (proximal: 14.98 ± 8.3; distal: 28.04 ± 6.3 mm) compared to the orifice. In case of the RCA, the distances from the orifice were much less (proximal: - 6.39 ± 2.9; mid: - 6.86 ± 7.0; distal: 17.95 ± 6.6 mm). The effect of these distances on pressure ratios at 100 Hgmm aortic pressure was between - 0.044 and 0.023. The correction for height differences changed the interpretation of the measurement (negative/positive result) in 5 (12%) and 11 (27%) cases for the FFR (cut-off value at 0.80) and the resting Pd/Pa (cut-off value at 0.92), respectively. The clinical implementation of hydrostatic pressure calculation should be considered during intracoronary pressure measurements. A correction for this parameter may become crucial in case of a borderline significant coronary artery stenosis, especially in distal coronary artery segments.
在日常临床实践中，通常会忽略静压对生理冠状动脉内测量的影响。我们的目的是研究这种对 Pd/Pa（远端/主动脉压）和 FFR（血流储备分数）的影响。选择了 41 个在 0.7 和 0.9 之间的 FFR 测量值。根据 3D 冠状动脉重建，定义了孔口和传感器之间的高度差，单位为毫米。通过从远端压力中减去静压梯度来调整静息 Pd/Pa 和 FFR。还对每个冠状动脉节段的 2D 侧投影进行了高度测量（n=305）。对于 LAD，每个节段的位置更高（近端：-13.69±5.4；中段：-46.13±6.1；远端：-56.80±7.7mm），而对于 CX，每个节段的位置更低（近端：14.98±8.3；远端：28.04±6.3mm）与孔口相比。对于 RCA，与孔口的距离要小得多（近端：-6.39±2.9；中段：-6.86±7.0；远端：17.95±6.6mm）。在 100Hgmm 主动脉压下，这些距离对压力比的影响在-0.044 到 0.023 之间。对于 FFR（截断值为 0.80）和静息 Pd/Pa（截断值为 0.92），高度差异的校正分别改变了 5 例（12%）和 11 例（27%）测量结果的解释（阴性/阳性结果）。在冠状动脉内压力测量过程中应考虑静压计算的临床实施。在临界显著冠状动脉狭窄的情况下，特别是在远端冠状动脉节段，该参数的校正可能变得至关重要。
