Elbasha Karim, Alotaibi Sultan, Samy Mohamed, Mankerious Nader, Toelg Ralph, Geist Volker, Richardt Gert, Allali Abdelhakim
Cardiology Department, Heart Center Segeberger Kliniken GmbH, Am Kurpak 1, 23795, Bad Segeberg, Germany.
Cardiology Department, Zagazig University, Sharkia, Egypt.
Clin Res Cardiol. 2024 Dec 23. doi: 10.1007/s00392-024-02589-x.
Coronary physiology to guide multi-vessel coronary intervention is associated with better outcome. In the presence of a coronary chronic total occlusion (CTO), hemodynamic evaluation of intermediate lesions in the donor coronary artery supplying a CTO territory still has limitations. We aim to evaluate implementing quantitative flow ratio (QFR) in assessing angiographically intermediate lesions of the main donor coronary artery supplying a CTO territory.
We recruited 219 patients with a single main donor vessel to a CTO territory from a single-center CTO registry between 2017 and 2020. Angiographically intermediate coronary lesions of the donor vessels were evaluated using offline QFR before and at a median of 6 months after successful percutaneous coronary intervention (PCI) of CTO.
The mean age of the study population was 66.9 ± 11.3 years, and 77.6% were males. Three-vessel disease was documented in 49.8%. The mean QFR value increased significantly in the donor vessels after successful CTO revascularization (0.93 ± 0.062 vs. 0.95 ± 0.046, p < 0.001) and was more prominent in donor vessels with angiographically intermediate stenosis (0.88 ± 0.063 vs. 0.92 ± 0.053, p < 0.001). While the change in QFR was not significant in angiographically normal donor vessel (0.97 ± 0.025 vs. 0.97 ± 0.026, p = 0.814). Fifteen patients had hemodynamically significant stenosis in the donor coronary artery (QFR ≤ 0.80) before CTO-PCI. Among those patients, 40% (n = 6) were turned to be non-significant with QFR > 0.80 after CTO recanalization, and 30% (n = 5) patients remained significant and were treated with PCI.
QFR overestimates the severity of intermediate coronary lesions of a donor vessel supplying a CTO territory like other invasive modalities for physiology assessment.
冠状动脉生理学指导多支冠状动脉介入治疗与更好的预后相关。在存在冠状动脉慢性完全闭塞（CTO）的情况下，对供应CTO区域的供血冠状动脉中间病变进行血流动力学评估仍存在局限性。我们旨在评估应用定量血流比（QFR）评估供应CTO区域的主要供血冠状动脉造影显示的中间病变。
我们从2017年至2020年的单中心CTO注册研究中招募了219例有单一主要供血血管供应CTO区域的患者。在成功进行CTO经皮冠状动脉介入治疗（PCI）之前和术后6个月（中位数），使用离线QFR评估供血血管造影显示的冠状动脉中间病变。
研究人群的平均年龄为66.9±11.3岁，77.6%为男性。49.8%的患者记录有三支血管病变。成功进行CTO血运重建后供血血管的平均QFR值显著增加（0.93±0.062对0.95±0.046，p<0.001），在造影显示有中间狭窄的供血血管中更为显著（0.88±0.063对0.92±0.053，p<0.001）。而在造影正常的供血血管中QFR的变化不显著（0.97±0.025对0.97±0.026，p=0.814）。15例患者在CTO-PCI前供血冠状动脉存在血流动力学显著狭窄（QFR≤0.80）。在这些患者中，40%（n=6）在CTO再通后QFR>0.80变为不显著，30%（n=5）的患者仍显著并接受了PCI治疗。
与其他用于生理学评估的有创方法一样，QFR高估了供应CTO区域的供血血管中间冠状动脉病变的严重程度。
