Tebaldi Matteo, Biscaglia Simone, Erriquez Andrea, Penzo Carlo, Tumscitz Carlo, Scoccia Alessandra, Quadri Giorgio, Sacchetta Giorgio, Folla Anna, Vadalà Giuseppe, Fileti Luca, Campo Gianluca
Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona, Ferrara, Italy.
Interventional Cardiology Uniti Rivoli Hospital Turin, Turin, Italy.
Catheter Cardiovasc Interv. 2021 Nov 15;98(6):1057-1065. doi: 10.1002/ccd.29380. Epub 2020 Nov 19.
To investigate the correlation between quantitative flow ratio (QFR), Pd/Pa, diastolic hyperemia-free ratio (DFR) and fractional flow reserve (FFR, gold standard) in non-culprit lesion (NCL) of patients with non ST-segment elevation myocardial infarction (NSTEMI).
The non-hyperemic pressure ratio (NHPR) and the angiography-based indexes have been developed to overcome the limitation of the use of the FFR.
Between January and December 2019, 184 NCL from 116 NSTEMI patients underwent physiologic assessment and were included in the study. NCLs were investigated with QFR, Pd/Pa, DFR, and FFR. Mean values of QFR, Pd/Pa, DFR and FFR were 0.85 ± 0.10, 0.92 ± 0.07, 0.93 ± 0.05 and 0.84 ± 0.07, respectively.
DFR and FFR showed a good correlation (r = 0.76). Bland and Altman plot showed a mean difference of 0.080. DFR Diagnostic accuracy was 88%. The area under the ROC curve (AUC) for DFR was 0.946 (95%CI 0.90-0.97, p = .0001). Similar findings were reported for Pd/Pa (r = 0.73; mean difference 0.095, diagnostic accuracy 84%, AUC 0.909 [95%CI 0.85-0.94, p = .0001]) and QFR (r = 0.68; mean difference 0.01; diagnostic accuracy 88%, AUC 0.964 [95% CI 0.91-0.98, p = .0001]). FFR, QFR, Pd/Pa and DFR identified 31%, 32%, 30% and 32% potentially flow-limiting lesions, respectively.
In NSTEMI patients, QFR, Pd/Pa and DFR showed equivalence as compared to gold standard FFR in the discrimination of non-culprit lesions requiring revascularization.
探讨非ST段抬高型心肌梗死（NSTEMI）患者非罪犯病变（NCL）的定量血流比（QFR）、Pd/Pa、舒张期无充血比（DFR）与血流储备分数（FFR，金标准）之间的相关性。
已开发出非充血压力比（NHPR）和基于血管造影的指标以克服FFR使用的局限性。
在2019年1月至12月期间，对116例NSTEMI患者的184处NCL进行了生理评估并纳入研究。使用QFR、Pd/Pa、DFR和FFR对NCL进行研究。QFR、Pd/Pa、DFR和FFR的平均值分别为0.85±0.10、0.92±0.07、0.93±0.05和0.84±0.07。
DFR与FFR显示出良好的相关性（r = 0.76）。Bland和Altman图显示平均差异为0.08。DFR的诊断准确性为88%。DFR的ROC曲线下面积（AUC）为0.946（95%CI 0.90 - 0.97，p = .0001）。Pd/Pa（r = 0.73；平均差异0.095，诊断准确性84%，AUC 0.909 [95%CI 0.85 - 0.94，p = .0001]）和QFR（r = 0.68；平均差异0.01；诊断准确性88%，AUC 0.964 [95%CI 0.91 - 0.98，p = .0001]）也有类似发现。FFR、QFR、Pd/Pa和DFR分别识别出31%、32%、30%和32%的潜在限流病变。
在NSTEMI患者中，在鉴别需要血运重建的非罪犯病变方面，QFR、Pd/Pa和DFR与金标准FFR表现相当。
