瞬时无波比测量的术前冠状动脉狭窄严重程度与吻合支术中血流传输时间的相关性。
Correlation between Preoperative Coronary Artery Stenosis Severity Measured by Instantaneous Wave-Free Ratio and Intraoperative Transit Time Flow Measurement of Attached Grafts.
机构信息
Department of Cardiac, Thoracic and Vascular Surgery, Hospital of Lithuanian University of Health Sciences Kauno Klinikos, Medical Academy, Lithuanian University of Health Sciences, Eivenių 2, LT-50009 Kaunas, Lithuania.
Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Eivenių 2, LT-50009 Kaunas, Lithuania.
出版信息
Medicina (Kaunas). 2020 Dec 18;56(12):714. doi: 10.3390/medicina56120714.
To assess the correlation between the degree of target coronary artery stenosis measured by instantaneous wave-free ratio (iFR) and the intraoperative transit time flow measurement (TTFM) of attached grafts as well as evaluate flow competition between the native coronary artery and the attached graft according to the severity of stenosis. In total, 89 grafts were subjected to intraoperative transit time flow measurement after coronary artery bypass grafting (CABG) in 25 patients with multivessel coronary artery disease (CAD). The iFR was evaluated for all coronary arteries with grafts. The coronary artery stenoses were divided into three groups based on the iFR value: iFR < 0.86 (group 1); iFR 0.86-0.90 (group 2); and iFR > 0.90 (group 3). The mean graft flow (MGF) was 46.9 ± 18.4 mL/min for group 1, 45.3 ± 20.9 mL/min for group 2, and 31.3 ± 18.5 mL/min for group 3. A statistically significant difference was confirmed between groups 1 and 3 ( = 0.002) and between groups 2 and 3 ( = 0.025). The pulsatility index (PI) was 2.49 ± 1.20 for group 1, 2.66 ± 2.13 for group 2, and 4.70 ± 3.66 for group 3. A statistically significant difference was found between groups 1 and 3 ( = 0.006) and between groups 2 and 3 ( = 0.032). Backward flow was detected in 7.5% of grafts for group 1, in 16.6% of grafts for group 2, and in 16% of grafts for group 3. A statistically significant difference was found between groups 1 and 2 ( = 0.025) and between groups 1 and 3 ( = 0.029). The iFR is a useful tool for predicting the impact of competitive flow observed between a native artery and an attached graft. The effect of competitive flow significantly increases when the graft is attached to a vessel with mild coronary stenosis. In a coronary artery where the iFR was not hemodynamically significant, the MGF was lower, the PI was higher, and a larger proportion of grafts with backward flow (BF) was detected compared to when there was significant stenosis (iFR < 0.86).
评估瞬时无波比（iFR）测量的靶冠状动脉狭窄程度与吻合支术中瞬时传输时间流量测量（TTFM）之间的相关性，并根据狭窄程度评估固有冠状动脉和吻合支之间的血流竞争。在 25 例多支冠状动脉疾病（CAD）患者中，共对 89 支吻合支进行了冠状动脉旁路移植术后的术中瞬时传输时间流量测量。对所有带有吻合支的冠状动脉进行 iFR 评估。根据 iFR 值将冠状动脉狭窄分为三组：iFR <0.86（组 1）；iFR 0.86-0.90（组 2）；iFR >0.90（组 3）。组 1 的平均吻合支流量（MGF）为 46.9 ± 18.4 mL/min，组 2 为 45.3 ± 20.9 mL/min，组 3 为 31.3 ± 18.5 mL/min。组 1 和组 3（ = 0.002）以及组 2 和组 3（ = 0.025）之间存在统计学显著差异。组 1 的脉动指数（PI）为 2.49 ± 1.20，组 2 为 2.66 ± 2.13，组 3 为 4.70 ± 3.66。组 1 和组 3（ = 0.006）以及组 2 和组 3（ = 0.032）之间存在统计学显著差异。组 1 的吻合支中检测到 7.5%存在逆流，组 2 中为 16.6%，组 3 中为 16%。组 1 和组 2（ = 0.025）以及组 1 和组 3（ = 0.029）之间存在统计学显著差异。iFR 是预测固有动脉和吻合支之间观察到的竞争血流影响的有用工具。当吻合支附着在轻度冠状动脉狭窄的血管上时，竞争血流的影响显著增加。在 iFR 无血流动力学意义的冠状动脉中，MGF 较低，PI 较高，与存在显著狭窄（iFR <0.86）相比，发现更多的吻合支存在逆流（BF）。
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