刘莉莉,沈迎,涂圣贤,虞林俊,张瑞岩,胡健,杨震坤,丁风华,沈卫峰

• 1:上海交通大学医学院附属瑞金医院心内科
• 2:上海交通大学生物医学工程学院

摘要(Abstract)：

目的探讨冠状动脉慢性完全闭塞(CTO)病变成功行经皮冠状动脉介入治疗(PCI对其供血动脉定量血流分数(QFR)的影响。方法入选上海交通大学医学院附属瑞金医院2017年7月至2021年1月成功行PCI的单支CTO病变且供血血管符合QFR计算标准的患者30例。分别于CTO病变血管开通前后应用不同的血流模型,即固定血流模型和对比剂血流模型,对供血血管进行QFR评估,观察CTO-PCI前后QFR值的变化,并收集患者的临床基线资料,分析其影响QFR值变化的因素。结果 CTO-PCI术后供血血管对比剂血流QFR值显著高于术前[(0.74±0.17)比(0.69±0.19),P<0.001],且冠状动脉侧支循环Rentrop分级是预测QFR变化值的独立预测因素(β=0.36,P=0.043)。结论 CTO-PCI术后供血血管QFR值是显著升高的,且与Rentrop侧支循环分级相关。

关键词(KeyWords)： 定量血流分数;慢性完全闭塞;经皮冠状动脉介入治疗

Abstract:

Keywords:

基金项目(Foundation): 国家自然科学基金（81770447）;; 上海交通大学医学院高峰高原计划（20181801）;上海交通大学“交大之星”计划医工交叉研究基金（YG2021ZD04）

作者(Author): 刘莉莉,沈迎,涂圣贤,虞林俊,张瑞岩,胡健,杨震坤,丁风华,沈卫峰

参考文献(References)：

• [1] Grantham JA, Marso SP, Spertus J, et al. Chronic total occlusion angioplasty in the United States. JACC Cardiovasc Interv, 2009, 2(6):479-486.
• [2] Brilakis ES, Mashayekhi K, Tsuchikane E, et al. Guiding principles for chronic total occlusion percutaneous coronary intervention.Circulation, 2019, 140(5):420-433.
• [3] Werner GS, Martin-Yuste V, Hildick-Smith D, et al. A randomized multicentre trial to compare revascularization with optimal medical therapy for the treatment of chronic total coronary occlusions. Eur Heart J, 2018, 39(26):2484-2493.
• [4] Choi JH, Chang SA, Choi JO, et al. Frequency of myocardial infarction and its relationship to angiographic collateral flow in territories supplied by chronically occluded coronary arteries.Circulation, 2013, 127(6):703-709.
• [5] Pirnat M, Stillman AE, Rienmueller R, et al. Can the degree of coronary collateralization be used in clinical routine as a valid angiographic parameter of viability? Int J Cardiovasc Imaging,2021, 37(2):379-388.
• [6] Baykan A, Kalkan G, Sahin D, et al. Coronary flow velocity reserve in donor artery and myocardial performance index after successful recanalization of chronic total coronary occlusions. J Invasive Cardiol, 2015, 27(6):E75-E81.
• [7] Ladwiniec A, Cunnington MS, Rossington J, et al. Collateral donor artery physiology and the influence of a chronic total occlusion on fractional flow reserve. Circ Cardiovasc Interv, 2015, 8(4):e002219.
• [8] Mohdnazri SR, Karamasis GV, Al-Janabi F, et al. The impact of coronary chronic total occlusion percutaneous coronary intervention upon donor vessel fractional flow reserve and instantaneous wavefree ratio:Implications for physiology-guided PCI in patients with CTO. Catheter Cardiovasc Interv, 2018, 92(3):E139-E148.
• [9] Xu B, Tu S, Qiao S, et al. Diagnostic accuracy of angiographybased quantitative flow ratio measurements for online assessment of coronary stenosis. J Am Coll Cardiol, 2017, 70(25):3077-3087.
• [10] Westra J, Andersen BK, Campo G, et al. Diagnostic performance of in-procedure angiography-derived quantitative flow reserve compared to pressure-derived fractional flow reserve:The FAVORⅡEurope-Japan Study. J Am Heart Assoc, 2018, 7(14):e009603.
• [11]沈卫峰，沈迎，丁风华，等.冠状动脉慢性完全闭塞病变病理生理机制和血运重建策略.中国介入心脏病学杂志，2019, 27(1):3-5.
• [12] Rentrop KP, Cohen M, Blanke H, et al. Changes in collateral channel fi lling immediately after controlled coronary artery occlusion by an angioplasty balloon in human subjects. JACC, 1985, 5(3):587-592.
• [13]冠状动脉血流储备分数临床应用专家共识专家组.冠状动脉血流储备分数临床应用专家共识.中华心血管病杂志，2016, 44(4):292-297.
• [14] Tu S, Westra J, Yang J, et al. Diagnostic accuracy of fast computational approaches to derive fractional flow reserve from diagnostic coronary angiography:the international multicenter FAVOR pilot study. JACC Cardiovasc Interv, 2016, 9(19):2024-2035.
• [15]李晨光，沈怡，戴宇翔，等.冠状动脉慢性完全闭塞病变侧支循环形成特点及影响因素探讨.中国介入心脏病学杂志，2012, 20(2):77-82.
• [16] Melikian N, Cuisset T, Hamilos M, et al. Fractional flow reservethe influence of the collateral circulation. Int J Cardiol, 2009, 132(3):e109-e110.
• [17] Sachdeva R, Agrawal M, Flynn S, et al. Reversal of ischemia of donor artery myocardium after recanalization of a chronic total occlusion. Catheter Cardiovasc Interv, 2013, 82(4):E453-E458.
• [18] Tigen K, Durmu?E, Sari I. Recanalization of a total occlusion with marked retrograde collateral supply:impact of collateral circulation on fractional flow reserve measurements of donor artery.J Invasive Cardiol, 2014, 26(6):E70-E75.
• [19]陈帅，龚冬火，沈迎，等.慢性完全闭塞病变侧支循环对供血动脉狭窄的生理学影响1例.中国介入心脏病学杂志，2019, 27(1):55-57.
• [20] Lee JH, Kim CY, Kim N, et al. Coronary collaterals function and clinical outcome between patients with acute and chronic total occlusion. JACC Cardiovasc Interv, 2017, 10(6):585-593.
• [21] Werner GS, Emig U, Mutschke O, et al. Regression of collateral function after recanalization of chronic total coronary occlusions:a serial assessment by intracoronary pressure and Doppler recordings.Circulation, 2003, 108(23):2877-2882.
• [22] Ozaki Y, Katagiri Y, Onuma Y, et al. CVIT expert consensus document on primary percutaneous coronary intervention(PCI)for acute myocardial infarction(AMI)in 2018. Cardiovasc Interv Ther, 2018, 33(2):178-203.
• [23] Ladwiniec A, Cunnington MS, Rossington J, et al. Microvascular dysfunction in the immediate aftermath of chronic total coronary occlusion recanalization. Catheter Cardiovasc Interv, 2016, 87(6):1071-1079.
• [24] Mejia-Renteria H, Lee JM, Lauri F, et al. Influence of microcirculatory dysfunction on angiography-based functional assessment of coronary stenoses. JACC Cardiovasc Interv, 2018, 11(8):741-753.