Kleczyński Paweł, Dziewierz Artur, Rzeszutko Łukasz, Dudek Dariusz, Legutko Jacek
Department of Interventional Cardiology, John Paul II Hospital, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland.
2 Department of Cardiology, University Hospital, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland.
Postepy Kardiol Interwencyjnej. 2020 Dec;16(4):384-390. doi: 10.5114/aic.2020.101762. Epub 2020 Dec 29.
Contrast medium Pd/Pa ratio (cFFR) was introduced as an alternative to fractional flow reserve (FFR).
To assess the accuracy of cFFR in predicting of FFR, quantitative flow ratio (QFR) and instantaneous wave-free ratio (iFR).
Resting Pd/Pa, cFFR, FFR, QFR, and iFR were measured in 110 intermediate coronary lesions. cFFR was obtained after intracoronary injection of contrast medium. FFR was measured after the intravenous administration of adenosine. QFR was derived from fixed empiric hyperemic flow velocity based on coronary angiography. iFR was calculated by measuring the resting pressure gradient across a coronary lesion during diastole.
Forty-four patients with 110 intermediate coronary lesions were enrolled. Mean baseline Pd/Pa was 0.93 ±0.05. Mean cFFR value was similar to FFR value (0.83 ±0.09 vs. 0.81 ±0.09; = 0.13) and QFR (0.81 ±0.1; = 0.69) and iFR (0.90 ±0.07; = 0.1). A total of 46 vessels (41.8%) had FFR ≤ 0.80, 50 (45.5%) vessels had cFFR ≤ 0.83, 44 (40.0%) vessels had QFR ≤ 0.80, and 38 (34.5%) vessels had iFR ≤ 0.89. An excellent agreement between cFFR and resting Pd/Pa, FFR, QFR, and iFR was confirmed (intraclass correlation coefficients of 0.83, 0.99, 0.98, and 0.88, respectively). The optimal cutoff value of cFFR was 0.83 for prediction of FFR ≤ 0.80 with sensitivity, specificity, and accuracy of 96.9%, 97.8%, and 97.3%, respectively. 100% sensitivity was observed for a cutoff value of 0.82 and 100% specificity for a cutoff value of 0.84; AUC = 0.998 (0.995-1.00); < 0.001.
Contrast medium Pd/Pa ratio seems to be accurate in predicting the functional significance of borderline coronary lesions assessed with FFR, iFR, and QFR.
引入对比剂Pd/Pa比值（cFFR）作为血流储备分数（FFR）的替代指标。
评估cFFR预测FFR、定量血流比（QFR）和瞬时无波比值（iFR）的准确性。
对110处中度冠状动脉病变进行静息Pd/Pa、cFFR、FFR、QFR和iFR测量。冠状动脉内注射对比剂后获得cFFR。静脉注射腺苷后测量FFR。QFR基于冠状动脉造影通过固定的经验性充血血流速度得出。iFR通过测量舒张期冠状动脉病变处的静息压力阶差计算得出。
纳入44例患有110处中度冠状动脉病变的患者。平均基线Pd/Pa为0.93±0.05。平均cFFR值与FFR值相似（0.83±0.09对0.81±0.09；P=0.13），与QFR（0.81±0.1；P=0.69）和iFR（0.90±0.07；P=0.1）相似。共有46支血管（41.8%）的FFR≤0.80，50支血管（45.5%）的cFFR≤0.83，44支血管（40.0%）的QFR≤0.80，38支血管（34.5%）的iFR≤0.89。证实cFFR与静息Pd/Pa、FFR、QFR和iFR之间具有良好的一致性（组内相关系数分别为0.83、0.99、0.98和0.88）。预测FFR≤0.80时，cFFR的最佳截断值为0.83，敏感性、特异性和准确性分别为96.9%、97.8%和97.3%。截断值为0.82时观察到100%的敏感性，截断值为0.84时观察到100%的特异性；曲线下面积（AUC）=0.998（0.995 - 1.00）；P<0.001。
对比剂Pd/Pa比值似乎能够准确预测通过FFR、iFR和QFR评估的临界冠状动脉病变的功能意义。
