Texas Children's Hospital, Baylor College of Medicine, 6651 Main Street, MC E1920, Houston, TX 77030 USA.
J Invasive Cardiol. 2021 Jan;33(1):E45-E51. doi: 10.25270/jic/20.00237.
Invasive fractional flow reserve (FFR) is considered the gold standard to evaluate coronary artery flow. Stress cardiovascular magnetic resonance (sCMR) is an emerging non-invasive tool to evaluate myocardial perfusion in children. We sought to compare sCMR with FFR to determine impaired intracoronary flow in children with anomalous aortic origin of a coronary artery (AAOCA) and/or myocardial bridge (MB) who presented concern for myocardial ischemia.
From December 2012 to May 2019, AAOCA and/or MB patients (<20 years old) were prospectively enrolled and underwent sCMR and FFR. Abnormal sCMR included perfusion/regional wall-motion abnormality in the involved coronary distribution. FFR was performed at baseline and with dobutamine/regadenoson and considered abnormal if <0.8 in the affected coronary segment.
Of 376 patients evaluated, a total of 19 (age range, 0.2-17 years) underwent 24 sets of sCMR and FFR studies, with 5 repeat studies following intervention. Types of anomalies included 6 isolated MB/normal CA origins, 5 single CAs, 5 left AAOCAs, and 3 right AAOCAs. Seventeen patients (89.5%) had MB/intramyocardial course - 14 involving the left anterior descending coronary artery and 3 with multivessel involvement. sCMR correlated with FFR in 19/24 sets (7 sCMR and FFR positive, 12 sCMR and FFR negative) and it did not correlate in 5/24 sets. The positive percent agreement was 77.8%, negative percent agreement was 80.0%, and overall percent agreement was 79.2%.
Assessment of myocardial perfusion using non-invasive sCMR concurred with FFR, particularly if performed with close proximity in time, and may contribute to risk stratification and decision making in children with AAOCA and/or MB.
有创性分流量比值（FFR）被认为是评估冠状动脉血流的金标准。压力心血管磁共振（sCMR）是一种新兴的非侵入性工具，可用于评估儿童的心肌灌注。我们旨在比较 sCMR 与 FFR，以确定患有主动脉异常起源冠状动脉（AAOCA）和/或心肌桥（MB）且疑似存在心肌缺血的儿童存在冠状动脉内血流受损的情况。
从 2012 年 12 月至 2019 年 5 月，前瞻性纳入 AAOCA 和/或 MB 患者（年龄<20 岁），并进行 sCMR 和 FFR 检查。异常的 sCMR 包括受累冠状动脉分布的灌注/节段性壁运动异常。FFR 在基线时进行，然后用多巴酚丁胺/雷卡地森进行检查，如果受累冠状动脉节段的 FFR<0.8，则认为异常。
在 376 例接受评估的患者中，共有 19 例（年龄 0.2-17 岁）进行了 24 组 sCMR 和 FFR 检查，其中 5 例在干预后进行了重复检查。异常类型包括 6 例孤立的 MB/正常 CA 起源、5 例单一 CA、5 例左 AAOCA 和 3 例右 AAOCA。17 例患者（89.5%）有 MB/心内走行-14 例涉及左前降支冠状动脉，3 例有多支血管受累。19/24 组的 sCMR 与 FFR 相关（7 组 sCMR 和 FFR 均阳性，12 组 sCMR 和 FFR 均阴性），而 5/24 组的 sCMR 与 FFR 不相关。阳性百分比一致率为 77.8%，阴性百分比一致率为 80.0%，总百分比一致率为 79.2%。
使用非侵入性 sCMR 评估心肌灌注与 FFR 一致，特别是如果在时间上密切接近时进行，这可能有助于 AAOCA 和/或 MB 患儿的风险分层和决策制定。
