团注法和连续热稀释法测量冠状动脉生理指标的重复性及相关性
Repeatability and Correlation of Coronary Physiology Indices Measured With Bolus and Continuous Thermodilution.
作者信息
Wong Christopher C Y, Dawson Luke P, Theriault-Lauzier Pascal, Skoda Annette, Luikart Helen, Tremmel Jennifer A, Khush Kiran K, Fearon William F
机构信息
Division of Cardiovascular Medicine, Stanford University School of Medicine and Stanford Cardiovascular Institute, CA (C.C.Y.W., L.P.D., P.T.-L., A.S., H.L., J.A.T., K.K.K., W.F.F.).
Division of Cardiology, University of Ottawa Heart Institute, Ontario, Canada (P.T.-L.).
出版信息
Circ Cardiovasc Interv. 2025 Apr;18(4):e014919. doi: 10.1161/CIRCINTERVENTIONS.124.014919. Epub 2025 Apr 15.
BACKGROUND
Previous studies have shown weak agreement between coronary physiology indices derived from continuous and bolus thermodilution, and suggested greater variability with bolus thermodilution measurements. This study aimed to evaluate the repeatability and correlation of continuous and bolus thermodilution-derived physiology indices in cardiac transplant recipients.
METHODS
Paired fractional flow reserve (FFR), coronary flow reserve (CFR), index of microcirculatory resistance (IMR), absolute hyperemic resistance (R), and microvascular resistance reserve (MRR) using continuous and bolus thermodilution were performed in consecutive cardiac transplant recipients.
RESULTS
In 20 patients, IMR was more repeatable than CFR and MRR derived from either continuous thermodilution (intraclass correlation coefficient, 0.95 versus 0.70 and 0.59; =0.004 and =0.002, respectively) or bolus thermodilution (intraclass correlation coefficient, 0.95 versus 0.20 and 0.33; <0.001 and =0.002, respectively), and similarly repeatable compared with R (intraclass correlation coefficient, 0.95 versus 0.87; =0.188). FFR by continuous thermodilution correlated with standard FFR measurements (=0.89, <0.001) but were significantly lower in value (0.87±0.05 versus 0.89±0.05; =0.004). CFR and MRR measurements using continuous thermodilution did not correlate with measurements using bolus thermodilution (=0.33, =0.170; =0.34, =0.155, respectively) and were significantly lower in value (2.9±1.0 versus 3.7±0.8, =0.003; 3.4±1.1 versus 4.8±1.3, <0.001, respectively). IMR and R did not correlate (=0.28, =0.226).
CONCLUSIONS
In cardiac transplant recipients, IMR had superior repeatability compared with CFR and MRR derived from either bolus or continuous thermodilution, and was equally repeatable compared with R. FFR, CFR, and MRR values obtained from continuous thermodilution were systematically lower compared with their counterparts obtained from bolus thermodilution.
背景
既往研究表明，连续热稀释法和团注热稀释法得出的冠状动脉生理指标之间一致性较弱，且提示团注热稀释法测量的变异性更大。本研究旨在评估心脏移植受者中连续热稀释法和团注热稀释法得出的生理指标的重复性及相关性。
方法
对连续的心脏移植受者进行配对的血流储备分数（FFR）、冠状动脉血流储备（CFR）、微循环阻力指数（IMR）、绝对充血阻力（R）以及使用连续热稀释法和团注热稀释法的微血管阻力储备（MRR）测量。
结果
在20例患者中，IMR的重复性高于连续热稀释法得出的CFR和MRR（组内相关系数分别为0.95对0.70和0.59；P分别=0.004和=0.002）或团注热稀释法得出的CFR和MRR（组内相关系数分别为0.95对0.20和0.33；P分别<0.001和=0.002），与R相比重复性相似（组内相关系数分别为0.95对0.87；P =0.188）。连续热稀释法得出的FFR与标准FFR测量值相关（r =0.89，P<0.001），但数值显著更低（0.87±0.05对0.89±0.05；P =0.004）。连续热稀释法测量的CFR和MRR与团注热稀释法测量值不相关（r分别=0.33，P =0.170；r =0.34，P =0.155），且数值显著更低（分别为2.9±1.0对3.7±0.8，P =0.003；3.4±1.1对4.8±1.3，P<0.001）。IMR和R不相关（r =0.28，P =0.226）。
结论
在心脏移植受者中，与团注或连续热稀释法得出的CFR和MRR相比，IMR具有更高的重复性，与R相比重复性相当。连续热稀释法得出的FFR、CFR和MRR值相较于团注热稀释法得出的对应值系统性更低。
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