Collateral Donor Artery Physiology and the Influence of a Chronic Total Occlusion on Fractional Flow Reserve
Collateral Donor Artery Physiology and the Influence of a Chronic Total Occlusion on Fractional Flow Reserve
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DOI：
10.1161/circinterventions.114.002219
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发表时间：
2015-04-01
影响因子：
5.6
通讯作者：
Hoye, Angela
中科院分区：
文献类型：
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作者：
Ladwiniec, Andrew;Cunnington, Michael S.;Hoye, Angela
背景-伴随慢性冠状动脉完全闭塞 (CTO) 和大量侧支循环的存在可能会改变受检血管的血流储备分数 (FFR)，使得 FFR 在预测 CTO 血管血运重建时的缺血情况时不可靠，并可能影响最佳血运重建策略的决策。我们测试了供体血管 FFR 在伴随 CTO 的经皮冠状动脉介入治疗后会显着变化的假设。方法和结果 - 在连续接受 CTO 经皮冠状动脉介入治疗的患者中，在经皮冠状动脉介入治疗之前和之后测量基线时的冠状动脉压力和流速以及两个非靶血管近端和远端段的充血情况。计算血流动力学，包括 FFR、绝对冠脉流量和冠脉流量速度-压力梯度关系。 46 名患者中的 34 名患者成功进行经皮冠状动脉介入治疗后，主要供体血管的 FFR 从 0.782 增加至 0.810（差异为 0.028 [0.012 至 0.044]；P=0.001）。根据心率压力乘积调整的基线供体血管绝对流量平均减少：177.5至139.9 mL/min（差值-37.6 [-62.6至-12.6]；P=0.005），充血流量平均减少：306.5至272.9 mL/min（差值，-33.5 [-58.7至-8.3]；P=0.011）。主要供体血管 FFR 的变化与血管造影 (%) 直径狭窄严重程度相关（r=0.44；P=0.009），并且与通过冠状动脉血流速度-压力梯度关系测量的狭窄严重程度密切相关（r=0.69；P
Background-The presence of a concomitant chronic total coronary occlusion (CTO) and a large collateral contribution might alter the fractional flow reserve (FFR) of an interrogated vessel, rendering the FFR unreliable at predicting ischemia should the CTO vessel be revascularized and potentially affecting the decision on optimal revascularization strategy. We tested the hypothesis that donor vessel FFR would significantly change after percutaneous coronary intervention of a concomitant CTO.Methods and Results-In consecutive patients undergoing percutaneous coronary intervention of a CTO, coronary pressure and flow velocity were measured at baseline and hyperemia in proximal and distal segments of both nontarget vessels, before and after percutaneous coronary intervention. Hemodynamics including FFR, absolute coronary flow, and the coronary flow velocity-pressure gradient relation were calculated. After successful percutaneous coronary intervention in 34 of 46 patients, FFR in the predominant donor vessel increased from 0.782 to 0.810 (difference, 0.028 [0.012 to 0.044]; P=0.001). Mean decrease in baseline donor vessel absolute flow adjusted for rate pressure product: 177.5 to 139.9 mL/min (difference -37.6 [-62.6 to -12.6]; P=0.005), mean decrease in hyperemic flow: 306.5 to 272.9 mL/min (difference, -33.5 [-58.7 to -8.3]; P=0.011). Change in predominant donor vessel FFR correlated with angiographic (%) diameter stenosis severity (r=0.44; P=0.009) and was strongly related to stenosis severity measured by the coronary flow velocity-pressure gradient relation (r=0.69; P