基于冠状动脉CT血管造影的血流储备分数和血流储备分数梯度用于预测未来冠状动脉事件
Fractional Flow Reserve and Fractional Flow Reserve Gradient From CCTA for Predicting Future Coronary Events.
作者信息
Hong David, Dai Neng, Lee Seung Hun, Shin Doosup, Choi Ki Hong, Kim Sung Mok, Kim Hyun Kuk, Jeon Ki-Hyun, Ha Sang Jin, Lee Kwan Yong, Park Taek Kyu, Yang Jeong Hoon, Song Young Bin, Hahn Joo-Yong, Choi Seung-Hyuk, Choe Yeon Hyeon, Gwon Hyeon-Cheol, Ge Junbo, Lee Joo Myung
机构信息
Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China.
出版信息
JACC Asia. 2024 Aug 27;4(10):735-747. doi: 10.1016/j.jacasi.2024.06.007. eCollection 2024 Oct.
BACKGROUND
Coronary computed tomography angiography-derived fractional flow reserve (FFR) is a per-vessel index reflecting cumulative hemodynamic burden while coronary events occur in focal lesions.
OBJECTIVES
The authors sought to evaluate the additive prognostic value of the local gradient of FFR (FFR gradient) in addition to FFR to predict future coronary events.
METHODS
The current study included 245 patients (634 vessels) who underwent coronary computed tomography angiography within 6 to 36 months before the index angiography, of which 209 vessels had future coronary events and 425 vessels did not. Future coronary events were defined as a composite of vessel-specific myocardial infarction or urgent revascularization during a mean interval of 1.5 years. Pre-existing disease patterns were classified according to FFR of ≤0.80 and FFR gradient of ≥0.025/mm.
RESULTS
Both FFR (per 0.01 decrease; adjusted HR: 1.040; 95% CI: 1.029-1.051; < 0.001) and FFR gradient (per 0.01 increase; adjusted HR: 1.144; 95% CI: 1.101-1.190; < 0.001) were significantly associated with the risk of future coronary events. Lesions with FFR gradient of ≥0.025/mm showed significantly higher risk of future coronary events than those with FFR gradient of <0.025/mm in both the FFR >0.80 (49.2% vs 30.1%; HR: 2.069; 95% CI: 1.265-3.385; = 0.004) and FFR ≤0.80 groups (60.9% vs 38.3%; HR: 1.988; 95% CI: 1.317-2.999; =0 .001). Adding FFR gradient into the model with FFR alone showed significantly increased predictability of future coronary events (global chi-square: 45.8 vs 39.9; = 0.015).
CONCLUSIONS
Patients with high FFR gradient showed increased risk of future coronary events irrespective of FFR. Integrating both FFR and FFR gradient showed incremental predictability of future coronary events compared with FFR alone. (Prediction and Validation of Clinical Course of Coronary Artery Disease With CT-Derived Non-Invasive Hemodynamic Phenotyping and Plaque Characterization [DESTINY Study]; NCT04794868).
背景
冠状动脉计算机断层扫描血管造影衍生的血流储备分数（FFR）是反映冠状动脉事件发生时局灶性病变累积血流动力学负荷的单支血管指标。
目的
作者旨在评估除FFR外，FFR局部梯度（FFR梯度）对预测未来冠状动脉事件的附加预后价值。
方法
本研究纳入了245例患者（634支血管），这些患者在索引血管造影前6至36个月接受了冠状动脉计算机断层扫描血管造影，其中209支血管发生了未来冠状动脉事件，425支血管未发生。未来冠状动脉事件定义为在平均1.5年的随访期内特定血管的心肌梗死或紧急血运重建的复合事件。根据FFR≤0.80和FFR梯度≥0.025/mm对既往疾病模式进行分类。
结果
FFR（每降低0.01；调整后HR：1.040；95%CI：1.029-1.051；P<0.001）和FFR梯度（每增加0.01；调整后HR：1.144；95%CI：1.101-1.190；P<0.001）均与未来冠状动脉事件风险显著相关。在FFR>0.80组（49.2%对30.1%；HR：2.069；95%CI：1.265-3.385；P=0.004）和FFR≤0.80组（60.9%对38.3%；HR：1.988；95%CI：1.317-2.999；P=0.001）中，FFR梯度≥0.025/mm的病变发生未来冠状动脉事件的风险均显著高于FFR梯度<0.025/mm的病变。将FFR梯度纳入仅包含FFR的模型中，显著提高了对未来冠状动脉事件的预测能力（全局卡方检验：45.8对39.9；P=0.015）。
结论
无论FFR如何，FFR梯度高的患者未来发生冠状动脉事件的风险增加。与单独使用FFR相比，综合使用FFR和FFR梯度对未来冠状动脉事件的预测能力有所提高。（冠状动脉疾病临床病程的CT衍生无创血流动力学表型和斑块特征预测与验证[DESTINY研究]；NCT04794868）
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