杨瑞鑫,陈青,张小天,孙冬冬,李成祥

• 1:第四军医大学学员旅
• 2:第四军医大学第一附属医院心血管内科

摘要(Abstract)：

目的评估冠状动脉造影筛选的冠状动脉多支病变与心肌缺血的关系,阐明血流储备分数(FFR)在指导冠状动脉多支病变治疗策略中的作用。方法纳入96例患者218处冠状动脉病变,根据FFR值分为两组,FFR>0.80组(113处)及FFR≤0.80组(105处)。结果 FFR≤0.80组冠状动脉直径狭窄程度更高[(66.2±10.5)%比(59.1±13.8)%,P<0.001]、面积狭窄百分比更大[(87.3±7.7)%比(81.4±10.9)%,P<0.001]、最小管腔直径更小[(0.86±0.36)mm比(1.18±0.49)mm,P<0.001],上述指标与FFR值无明确相关(相关系数分别为r=-0.286,P<0.001;r=-0.282,P<0.001)。冠状动脉最小管腔直径与FFR值呈正相关(r=0.364,P<0.001)。冠状动脉造影筛选的96例患者中,26例为三支病变,70例为双支病变;经FFR测量后,缺血相关的三支病变10例,两支病变29例,单支病变17例。QCA冠状动脉造影直径狭窄≥70%,FFR>0.80的病变为21处(9.6%);QCA冠状动脉造影直径狭窄<70%,FFR≤0.80的病变为53处(24.3%)。QCA冠状动脉造影直径狭窄≥70%,FFR≤0.80的病变为52处(23.9%)(Matches);QCA冠状动脉造影直径狭窄<70%,FFR>0.80的病变为92处(42.2%)(Matches)。QCA冠状动脉造影面积狭窄≥70%,FFR>0.80的病变为89处(40.8%)(Mismatches);QCA冠状动脉造影面积狭窄≥70%,FFR≤0.80的病变为105处(48.2%)(Matches);QCA冠状动脉造影面积狭窄<70%,FFR>0.80的病变为24处(11.0%)(Matches)。结论 FFR在指导冠状动脉多支病变治疗策略中具有重要意义,可显著降低缺血相关靶病变个数。

关键词(KeyWords)： 冠状动脉疾病;血流储备分数;血管造影术

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 杨瑞鑫,陈青,张小天,孙冬冬,李成祥

参考文献(References)：

• [1]Moses JW,Stone GW,Nikolsky E,et al.Drug-eluting stents in the treatment of intermediate lesions:pooled analysis from four randomized trials.J Am Coll Cardiol,2006,47:2164-2171.
• [2]Pijls NH,van Son JA,Kirkeeide RL,et al.Experimental basis of determining maximum coronary,myocardial,and collateral blood flow by pressure measurements for assessing functional stenosis severity before and after percutaneous transluminal coronary angioplasty.Circulation,1993,87:1354-1367.
• [3]Pijls NH,De Bruyne B,Peels K,et al.Measurement of fractional flow reserve to assess the functional severity of coronaryartery stenoses.N Engl J Med,1996,334:1703-1708.
• [4]De Bruyne B,Sarma J.Fractional flow reserve:a review:invasive imaging.Heart,2008,94:949-959.
• [5]Pijls NH,van Schaardenburgh P,Manoharan G,et al.Percutaneous coronary intervention of functionally nonsignificant stenosis:5-year follow-up of the DEFER Study.J Am Coll Cardiol,2007,49:2105-2111.
• [6]Courtis J,Rodés-Cabau J,Larose E,et al.Usefulness of coronary fractional flow reserve measurements in guiding clinical decisions in intermediate or equivocal left main coronary stenoses.Am J Cardiol,2009,103:943-949.
• [7]Tonino PA,De Bruyne B,Pijls NH,et al.Fractional flow reserve versus angiography for guiding percutaneous coronary intervention.N Engl J Med,2009,360:213-224.
• [8]De Bruyne B,Pijls NH,Bartunek J,et al.Fractional flow reserve in patients with prior myocardial infarction.Circulation,2001,104:157-162.
• [9]McClish JC,Ragosta M,Powers ER,et al.Effect of acute myocardial infarction on the utility of fractional flow reserve for the physiologic assessment of the severity of coronary artery narrowing.Am J Cardiol,2004,93:1102-1106.
• [10]Berger A,Botman KJ,MacCarthy PA,et al.Long-term clinical outcome after fractional flow reserve-guided percutaneous coronary intervention in patients with multivessel disease.J Am Coll Cardiol,2005,46:438-442.
• [11]Topol EJ,Nissen SE.Our preoccupation with coronary luminology.The dissociation between clinical and angiographic findings in ischemic heart disease.Circulation,1995,92:2333-2342.
• [12]Yoon YW,Shin S,Kim BK,et al.Usefulness of intravascular ultrasound to predict outcomes in short-length lesions treated with drug-eluting stents.Am J Cardiol,2013,112:642-646.
• [13]Amabile N,Souteyrand G,Ghostine S,et al.Very late stent thrombosis related to incomplete neointimal coverage or neoatherosclerotic plaque rupture identified by optical coherence tomography imaging.Eur Heart J Cardiovasc Imaging,2013 May29.[Epub ahead of print].
• [14]De Bruyne B,Sarma J.Fractional flow reserve:a review:invasive imaging.Heart,2008,94:949-959.
• [15]Courtis J,Rodés-Cabau J,Larose E,et al.Usefulness of coronary fractional flow reserve measurements in guiding clinical decisions in intermediate or equivocal left main coronary stenoses.Am J Cardiol,2009,103:943-949.