Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
Department of Epidemiology & Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
Eur Heart J Cardiovasc Imaging. 2022 Jun 1;23(6):743-752. doi: 10.1093/ehjci/jeab263.
Coronary flow capacity (CFC) integrates quantitative hyperaemic myocardial blood flow (hMBF) and coronary flow reserve (CFR) to comprehensively assess physiological severity of coronary artery disease (CAD). This study evaluated the effects of revascularization on CFC as assessed by serial [15O]H2O positron emission tomography (PET) perfusion imaging.
A total of 314 patients with stable CAD underwent [15O]H2O PET imaging at baseline and after myocardial revascularization to assess changes in hMBF, CFR, and CFC in 415 revascularized vessels. Using thresholds for ischaemia and normal perfusion, vessels were stratified in five CFC categories: myocardial steal, severely reduced CFC, moderately reduced CFC, minimally reduced CFC, and normal flow. Additionally, the association between CFC increase and the composite endpoint of death and non-fatal myocardial infarction (MI) was studied. Vessel-specific CFC improved after revascularization (P < 0.01). Furthermore, baseline CFC was an independent predictor of CFC increase (P < 0.01). The largest changes in ΔhMBF (0.90 ± 0.74, 0.93 ± 0.65, 0.79 ± 0.74, 0.48 ± 0.61, and 0.29 ± 0.66 mL/min/g) and ΔCFR (1.01 ± 0.88, 0.99 ± 0.69, 0.87 ± 0.88, 0.66 ± 0.91, and -0.01 ± 1.06) were observed in vessels with lower baseline CFC (P < 0.01 for both). During a median follow-up of 3.5 (95% CI 3.1-3.9) years, an increase in CFC was independently associated with lower rates of death and non-fatal MI (HR 0.43, 95% CI 0.19-0.98, P = 0.04).
Successful revascularization results in an increase in CFC. Furthermore, baseline CFC was an independent predictor of change in hMBF, CFR, and subsequently CFC. In addition, an increase in CFC was associated with a favourable outcome in terms of death and non-fatal MI.
冠脉血流储备（CFR）综合评估了定量充血心肌血流（hMBF）和冠脉血流储备（CFR），可全面评估冠状动脉疾病（CAD）的生理严重程度。本研究通过连续[15O]H2O 正电子发射断层扫描（PET）灌注成像评估了血运重建对 CFC 的影响。
共 314 例稳定性 CAD 患者在基线和血运重建后接受[15O]H2O PET 成像，以评估 415 个血运重建血管中 hMBF、CFR 和 CFC 的变化。使用缺血和正常灌注的阈值，根据 CFC 将血管分为五类：心肌盗血、严重 CFC 降低、中度 CFC 降低、轻度 CFC 降低和正常血流。此外，还研究了 CFC 增加与死亡和非致死性心肌梗死（MI）复合终点的相关性。血管特异性 CFC 在血运重建后改善（P < 0.01）。此外，基线 CFC 是 CFC 增加的独立预测因子（P < 0.01）。ΔhMBF（0.90 ± 0.74、0.93 ± 0.65、0.79 ± 0.74、0.48 ± 0.61 和 0.29 ± 0.66 mL/min/g）和 ΔCFR（1.01 ± 0.88、0.99 ± 0.69、0.87 ± 0.88、0.66 ± 0.91 和 -0.01 ± 1.06）的最大变化发生在基线 CFC 较低的血管中（P < 0.01）。在中位数为 3.5 年（95%CI 3.1-3.9）的随访期间，CFC 的增加与死亡和非致死性 MI 的发生率降低独立相关（HR 0.43，95%CI 0.19-0.98，P = 0.04）。
成功的血运重建导致 CFC 增加。此外，基线 CFC 是 hMBF、CFR 变化的独立预测因子，进而也是 CFC 的独立预测因子。此外，CFC 的增加与死亡和非致死性 MI 结局的改善相关。
