Measurement of fractional flow reserve to assess the functional severity of coronary-artery stenoses
Measurement of fractional flow reserve to assess the functional severity of coronary-artery stenoses
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DOI：
10.1056/nejm199606273342604
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发表时间：
1996-06-27
影响因子：
158.5
通讯作者：
Koolen, JJ
中科院分区：
文献类型：
--
作者：
Pijls, NHJ;DeBruyne, B;Koolen, JJ
背景。中度冠状动脉狭窄的临床意义可能很难确定。心肌血流储备分数 (FFR) 是冠状动脉狭窄功能严重程度的新指标，根据冠状动脉造影期间的压力测量计算得出。我们将该指标与常用于检测心肌缺血的无创测试结果进行比较，以确定该指标的有用性。 方法。我们连续对 45 名患有中度冠状动脉狭窄和不明原因胸痛的患者进行了自行车运动试验、铊闪烁扫描、多巴酚丁胺负荷超声心动图和定量冠状动脉造影，并将结果与 FFR 测量结果进行了比较。在所有 21 名 FFR 低于 0.75 的患者中，至少一项无创测试明确证明了可逆性心肌缺血。进行冠状动脉成形术或搭桥手术后，所有阳性检测结果均恢复正常。相比之下，24 名 FFR 为 0.75 或更高的患者中，有 21 名在所有非侵入性测试中均呈可逆性心肌缺血阴性。这些患者没有进行血运重建手术，并且在 14 个月的随访期间也不需要进行任何血运重建手术。 FFR识别可逆性缺血的敏感性为88%，特异性为100%，阳性预测值为100%，阴性预测值为88%，准确性为93%。结论。对于中度严重冠状动脉狭窄的患者，FFR 似乎是狭窄功能严重程度和冠状动脉血运重建需求的有用指标。 (C) 1996 年，马萨诸塞州医学会。
Background. The clinical significance of coronary-artery stenoses of moderate severity can be difficult to determine. Myocardial fractional flow reserve (FFR) is a new index of the functional severity of coronary stenoses that is calculated from pressure measurements made during coronary arteriography. We compared this index with the results of noninvasive tests commonly used to detect myocardial ischemia, to determine the usefulness of the index.Methods. In 45 consecutive patients with moderate coronary stenosis and chest pain of uncertain origin, we performed bicycle exercise testing, thallium scintigraphy, stress echocardiography with dobutamine, and quantitative coronary arteriography and compared the results with measurements of FFR.Results. In all 21 patients with an FFR of less than 0.75, reversible myocardial ischemia was demonstrated unequivocally on at least one noninvasive test. After coronary angioplasty or bypass surgery was performed, all the positive test results reverted to normal. In contrast, 21 of the 24 patients with an FFR of 0.75 or higher tested negative for reversible myocardial ischemia on all the noninvasive tests. No revascularization procedures were performed in these patients, and none were required during 14 months of follow-up. The sensitivity of FFR in the identification of reversible ischemia was 88 percent, the specificity 100 percent, the positive predictive value 100 percent, the negative predictive value 88 percent, and the accuracy 93 percent.Conclusions. In patients with coronary stenosis of moderate severity, FFR appears to be a useful index of the functional severity of the stenoses and the need for coronary revascularization. (C) 1996, Massachusetts Medical Society.