年龄与对不同充血剂的血管舒张反应：腺苷与造影剂对比
Age and Vasodilator Response to Different Hyperemic Agents: Adenosine versus Contrast Medium.
作者信息
Galante Domenico, Migliaro Stefano, Di Giusto Federico, Anastasia Gianluca, Petrolati Edoardo, Vicerè Andrea, Zimbardo Giuseppe, Cialdella Pio, Romagnoli Enrico, Aurigemma Cristina, Burzotta Francesco, Trani Carlo, Martin-Reyes Roberto, Baptista Sergio Bravo, Faria Daniel, Amabile Nicolas, Raposo Luis, Crea Filippo, Leone Antonio Maria
机构信息
Diagnostic, Interventional and Acute Cardiac Care Unit, Ospedale Isola Tiberina - Gemelli Isola, 00186 Rome, Italy.
Clinical, Interventional and Hemodynamic Cardiology Unit, Aurelia Hospital, 00165 Rome, Italy.
出版信息
Rev Cardiovasc Med. 2024 Jul 2;25(7):239. doi: 10.31083/j.rcm2507239. eCollection 2024 Jul.
BACKGROUND
Age-related remodelling has the potential to affect the microvascular response to hyperemic stimuli. However, its precise effects on the vasodilatory response to adenosine and contrast medium, as well as its influence on fractional flow reserve (FFR) and contrast fractional flow reserve (cFFR), have not been previously investigated. We investigate the impact of age on these indices.
METHODS
We extrapolated data from the post-revascularization optimization and physiological evaluation of intermediate lesions using fractional flow reserve (PROPHET-FFR) and The Multi-center Evaluation of the Accuracy of the Contrast MEdium INduced Pd/Pa RaTiO in Predicting (MEMENTO) studies. Only lesions with a relevant vasodilatory response to adenosine and contrast medium were considered of interest. A total of 2080 patients, accounting for 2294 pressure recordings were available for analysis. The cohort was stratified into three age terciles. Age-dependent correlations with FFR, cFFR, distal pressure/aortic pressure (Pd/Pa) and instantaneous wave-free ratio (iFR) were calculated. The vasodilatory response was calculated in 1619 lesions (with both FFR and cFFR) as the difference between resting and hyperaemic pressure ratios and correlated with aging. The prevalence of FFR-cFFR discordance was assessed.
RESULTS
Age correlated positively to FFR (r = 0.062, = 0.006), but not with cFFR (r = 0.024, = 0.298), Pd/Pa (r = -0.015, = 0.481) and iFR (r = -0.026, = 0.648). The hyperemic response to adenosine (r = -0.102, 0.0001) and to contrast medium (r = -0.076, = 0.0023) showed a negative correlation with age. When adjusted for potential confounders, adenosine induced hyperaemia was negatively associated with age ( = 0.04 vs = 0.08 for cFFR). Discordance decreased across age terciles (14.64% vs 12.72% vs 10.12%, = 0.032).
CONCLUSIONS
As compared to adenosine, contrast induced hyperaemia appeared to be less affected by age. cFFR may be considered a more stable and reproducible tool to assess epicardial stenosis in elderly patients.
CLINICAL TRIAL REGISTRATION
PROPHET-FFR STUDY, Clinicaltrials.gov (NCT05056662).
背景
与年龄相关的重塑有可能影响微血管对充血刺激的反应。然而，其对腺苷和造影剂血管舒张反应的精确影响，以及对血流储备分数（FFR）和造影剂血流储备分数（cFFR）的影响，此前尚未得到研究。我们研究年龄对这些指标的影响。
方法
我们从使用血流储备分数进行的血管重建术后中间病变优化和生理评估（PROPHET - FFR）研究以及造影剂诱导的Pd/Pa比值预测准确性的多中心评估（MEMENTO）研究中推断数据。仅考虑对腺苷和造影剂有相关血管舒张反应的病变。共有2080例患者，2294次压力记录可供分析。该队列被分为三个年龄三分位数组。计算年龄与FFR、cFFR、远端压力/主动脉压力（Pd/Pa）和瞬时无波比值（iFR）之间的相关性。在1619个病变（同时有FFR和cFFR）中计算血管舒张反应，即静息和充血压力比值之差，并与年龄相关。评估FFR - cFFR不一致的发生率。
结果
年龄与FFR呈正相关（r = 0.062，P = 0.006），但与cFFR（r = 0.024，P = 0.298）、Pd/Pa（r = -0.015，P = 0.481）和iFR（r = -0.026，P = 0.648）无相关性。对腺苷（r = -0.102，P < 0.0001）和造影剂（r = -0.076，P = 0.0023）的充血反应与年龄呈负相关。在调整潜在混杂因素后，腺苷诱导的充血与年龄呈负相关（cFFR方面，P = 0.04对比P = 0.08）。FFR - cFFR不一致在年龄三分位数组中逐渐降低（14.64%对12.72%对10.12%，P = 0.032）。
结论
与腺苷相比，造影剂诱导的充血似乎受年龄影响较小。cFFR可被认为是评估老年患者心外膜狭窄更稳定、可重复的工具。
临床试验注册
PROPHET - FFR研究，Clinicaltrials.gov（NCT05056662）
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