比较有中度冠状动脉病变患者的血管血流储备分数与有创静息全周期比值。
Comparison of vessel fractional flow reserve with invasive resting full-cycle ratio in patients with intermediate coronary lesions.
机构信息
University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, Kerpener Str. 62, 50937 Cologne, Germany.
University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, Kerpener Str. 62, 50937 Cologne, Germany.
出版信息
Int J Cardiol. 2023 Apr 15;377:1-8. doi: 10.1016/j.ijcard.2023.01.062. Epub 2023 Jan 21.
BACKGROUND
Vessel fractional flow reserve (vFFR) is a novel angiography-derived index for the assessment of myocardial ischemia without the need for pressure wires and hyperemic agents. vFFR has demonstrated very good diagnostic performance compared with the hyperemic index fractional flow reserve (FFR). The aim of this study was to compare vFFR to the non-hyperemic pressure ratio resting full-cycle ratio (RFR).
METHODS
This was a retrospective, observational, single-center study of an all-comer cohort undergoing RFR assessment. Invasive coronary angiography was obtained without a dedicated vFFR acquisition protocol, and vFFR calculation was attempted in all vessels interrogated by RFR (1483 lesions of 1030 patients).
RESULTS
vFFR could be analyzed in 986 lesions from 705 patients. Median diameter stenosis was 37% (interquartile range (IQR): 30.0-44.0%), vFFR 0.86 (IQR: 0.81-0.91) and RFR 0.94 (IQR: (0.90-0.97). The correlation between vFFR and RFR was strong (r = 0.70, 95% confidence interval (CI): 0.66-0.74, p < 0.001). Using RFR ≤0.89 as reference, the sensitivity, specificity, positive predictive value, negative predictive value, and overall diagnostic accuracy for vFFR were 77%, 93%, 77%, and 92% and 89%. vFFR yielded a high area under the curve (AUC) of 0.92 (95% CI: 0.90-0.94). The good diagnostic performance of vFFR was confirmed among subgroups of patients with diabetes, severe aortic stenosis, female gender and lesions located in the left anterior descending artery.
CONCLUSION
vFFR has a high diagnostic performance taking RFR as the reference standard for evaluating the functional significance of coronary stenoses.
背景
血管分数流量储备（vFFR）是一种新的血管造影衍生指数，用于评估心肌缺血，无需使用压力导丝和充血剂。与充血指数血流储备分数（FFR）相比，vFFR 具有非常好的诊断性能。本研究旨在比较 vFFR 与非充血性压力比静息全周期比（RFR）。
方法
这是一项回顾性、观察性、单中心的研究，纳入了所有接受 RFR 评估的患者。进行了侵入性冠状动脉造影术，但未进行专门的 vFFR 采集方案，对 RFR 检测的所有血管（1030 例患者的 1483 个病变）尝试进行 vFFR 计算。
结果
可以对 705 例患者的 986 个病变进行 vFFR 分析。中位直径狭窄为 37%（四分位间距（IQR）：30.0-44.0%），vFFR 为 0.86（IQR：0.81-0.91），RFR 为 0.94（IQR：（0.90-0.97）。vFFR 与 RFR 之间具有很强的相关性（r=0.70，95%置信区间（CI）：0.66-0.74，p<0.001）。以 RFR≤0.89 为参考，vFFR 的灵敏度、特异性、阳性预测值、阴性预测值和总体诊断准确性分别为 77%、93%、77%、92%和 89%。vFFR 的曲线下面积（AUC）很高，为 0.92（95%CI：0.90-0.94）。在糖尿病、严重主动脉瓣狭窄、女性和病变位于左前降支的患者亚组中，vFFR 的诊断性能得到了证实。
结论
以 RFR 为参考标准，vFFR 对评估冠状动脉狭窄的功能意义具有较高的诊断性能。
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