Tas Ahmet, Ozcan Alp, Alan Yaren, Umman Sabahattin, Parker Kim H, van de Hoef Tim P, Sezer Murat, Piek Jan J
Department of Cardiology, Amsterdam UMC, Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands.
Emergency Department, Gomec State Hospital, Balikesir, Turkey.
Physiol Rep. 2025 Jul;13(13):e70440. doi: 10.14814/phy2.70440.
A significant proportion of stenoses have an abnormal fractional flow reserve (FFR) after angiographically successful percutaneous coronary intervention (PCI), which is traditionally attributed to differences in coronary flow velocity reserve (CFVR) or hyperemic microvascular resistance (hMR). This study investigated the mechanisms underlying residual low FFR despite good angiographic results and normalized hyperemic stenosis resistance (hSR) using wave-intensity analysis (WIA), which evaluates phasic characteristics of cardiac-coronary coupling. Sixty-three vessels from patients who underwent PCI for stable intermediate stenoses were included. Peri-PCI characteristics of conventional and WIA parameters were assessed. Ten (16%) vessels exhibited residual low FFR (≤0.8) despite normalized hSR (<0.8), without significant differences in hyperemic flow (velocity) (hAPV), CFVR, or hMR compared with concordant normal FFR-hSR group (p > 0.05). WIA revealed a significantly slower (peak-time of backward expansion wave, tBEW = 20% ± 6% vs. 29% ± 17% of expansion period, p = 0.005) and weaker (BEW = 10.1 ± 8.9 vs. 15.8 ± 11.4 10.kW.m-2.s-2, p = 0.045) impact of microvascular suction responsible for diastolic coronary filling during hyperemia in the low FFR group, despite comparable pre-PCI characteristics. Residual low FFR after PCI may reflect altered cardiac-coronary coupling without limitation of flow or vasodilator capacity when the blunted impact of accelerating wave energy flux with delayed coronary filling fails to sustain distal pressure. The influence of cardiac-coronary coupling on post-PCI FFR warrants further investigation.
在血管造影成功的经皮冠状动脉介入治疗（PCI）后，相当一部分狭窄病变存在异常的血流储备分数（FFR），传统上认为这归因于冠状动脉血流速度储备（CFVR）或充血性微血管阻力（hMR）的差异。本研究使用波强度分析（WIA）来评估心脏 - 冠状动脉耦合的相位特征，探讨了尽管血管造影结果良好且充血性狭窄阻力（hSR）正常，但仍存在残余低FFR的潜在机制。纳入了63例因稳定的中度狭窄接受PCI治疗患者的血管。评估了PCI前后传统参数和WIA参数的特征。尽管hSR正常化（<0.8），但仍有10支（16%）血管表现出残余低FFR（≤0.8），与FFR - hSR一致的正常组相比，充血血流（速度）（hAPV）、CFVR或hMR无显著差异（p>0.05）。WIA显示，尽管PCI前特征相当，但低FFR组在充血期间负责舒张期冠状动脉充盈的微血管抽吸作用明显更慢（反向扩张波的峰值时间，tBEW = 扩张期的20%±6% vs. 29%±17%，p = 0.005）且更弱（BEW = 10.1±8.9 vs. 15.8±11.4 10.kW.m-2.s-2，p = 0.045）。PCI后残余低FFR可能反映了心脏 - 冠状动脉耦合的改变，当加速波能量通量的减弱影响与延迟的冠状动脉充盈未能维持远端压力时，血流或血管舒张能力不受限制。心脏 - 冠状动脉耦合对PCI后FFR的影响值得进一步研究。
