Matsuda Kazuki, Hoshino Masahiro, Usui Eisuke, Hanyu Yoshihiro, Sugiyama Tomoyo, Kanaji Yoshihisa, Hada Masahiro, Nagamine Tatsuhiro, Nogami Kai, Ueno Hiroki, Sayama Kodai, Sakamoto Tatsuya, Yonetsu Taishi, Sasano Tetsuo, Kakuta Tsunekazu
Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan.
Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
Quant Imaging Med Surg. 2024 Jan 3;14(1):421-431. doi: 10.21037/qims-23-416. Epub 2023 Sep 4.
Coronary flow reserve (CFR) provides prognostication and coronary physiological information, including epicardial coronary stenosis and microvascular function. The relationship between stress transthoracic Doppler echocardiography (TDE)-derived coronary flow velocity reserve (CFR) and thermodilution-derived coronary flow reserve (CFR) before and after elective percutaneous coronary intervention (PCI) remains unclear.
This single-center prospective registry study evaluated patients who underwent fractional flow reserve (FFR)-guided elective PCI for left anterior descending artery (LAD) lesions with wire-based invasive physiological measurements and pre- and post-PCI stress TDE examinations.
A total of 174 LAD lesions from 174 patients were included in the final analysis. A modest correlation was detected between the pre-PCI CFR and the pre-PCI CFR (r=0.383, P<0.001). The frequently used CFR threshold of 2.0 corresponded to a pre-PCI CFR of 2.18. Pre-PCI CFR underestimated pre-PCI CFR [1.89 (1.44-2.31) 2.05 (1.38-2.93), P<0.001]. Both CFR and CFR increased significantly post-PCI [pre-PCI CFR 1.89 post-PCI CFR 2.33, P<0.001; pre-PCI CFR 2.05 (1.38-2.93) post-PCI CFR 2.59 (1.63-3.55), P<0.001]. In contrast, there was no significant relationship between changes in CFR and changes in CFR after PCI (r=0.008, P=0.915) or between post-PCI CFR and post-PCI CFR (r=0.054, P=0.482).
Pre-PCI CFR and CFR are modestly correlated, but post-PCI CFR and CFR have no correlation. CFR and CFR are not interchangeable, particularly post-PCI, suggesting that the two metrics represent different coronary physiologies after PCI.
冠状动脉血流储备（CFR）可提供预后及冠状动脉生理信息，包括心外膜冠状动脉狭窄和微血管功能。在择期经皮冠状动脉介入治疗（PCI）前后，经胸壁应力多普勒超声心动图（TDE）得出的冠状动脉血流速度储备（CFR）与热稀释法得出的冠状动脉血流储备（CFR）之间的关系尚不清楚。
这项单中心前瞻性注册研究评估了因左前降支（LAD）病变接受血流储备分数（FFR）引导的择期PCI的患者，采用基于导丝的有创生理测量以及PCI前后的应力TDE检查。
最终分析纳入了174例患者的174处LAD病变。PCI前的CFR与PCI前的CFR之间存在适度相关性（r = 0.383，P < 0.001）。常用的CFR阈值2.0对应于PCI前的CFR为2.18。PCI前的CFR低估了PCI前的CFR [1.89（1.44 - 2.31）对2.05（1.38 - 2.93），P < 0.001]。PCI后CFR和CFR均显著增加[PCI前CFR 1.89对PCI后CFR 2.33，P < 0.001；PCI前CFR 2.05（1.38 - 2.93）对PCI后CFR 2.59（1.63 - 3.55），P < 0.001]。相比之下，PCI后CFR的变化与CFR的变化之间无显著关系（r = 0.008，P = 0.915），PCI后的CFR与PCI后的CFR之间也无显著关系（r = 0.054，P = 0.482）。
PCI前的CFR与CFR存在适度相关性，但PCI后的CFR与CFR无相关性。CFR和CFR不可互换，尤其是在PCI后，这表明这两个指标代表了PCI后不同的冠状动脉生理状态。
