Angiogram based fractional flow reserve in patients with dual/triple vessel coronary artery disease
Angiogram based fractional flow reserve in patients with dual/triple vessel coronary artery disease
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DOI：
10.1016/j.ijcard.2019.01.072
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发表时间：
2019-05-15
影响因子：
3.5
通讯作者：
Matsuo, H.
中科院分区：
文献类型：
--
作者：
Omori, H.;Witberg, G.;Matsuo, H.
目的：评价血管造影衍生分数血流储备（FFRangio）在多血管病变（MVD）患者血管造影中的应用价值。背景：FFR是冠状动脉狭窄生理评估和指导血运重建的参考标准，特别是在MVD患者中，但它仍然严重未被充分利用。基于非导线的FFRangio在非MVD患者中表现良好，但其在MVD中的准确性尚不清楚。方法：在日本岐阜心脏中心进行前瞻性临床研究。患者使用线基FFR （wbFFR）和FFRangio对所有相关冠状动脉病变进行生理评估。主要终点是FFRangio的诊断性能（敏感性、特异性、准确性），以wbFFR为参考。其他结果包括wbFFR/FFRangio之间的相关性、wbFFR/FFRangio测量所需的时间以及wbFFR/FFRangio对冠状动脉疾病严重程度重新分类的影响。结果：共纳入50例患者（118个病变）。平均年龄72±9岁，72%为男性，36%为三支血管病变，SYNTAX平均评分为13分。wbFFR和FFRangio的平均值分别为0.83 +/- 0.12和0.81 +/- 0.11。FFRangio的准确性、敏感性和特异性分别为92.3% （95% CI 79.1-98.4%）、92.4% （95% CI 84.3-97.2%）和92.4% （95% CI 87.4-97.3%）。wbFFR与FFRangio之间的Pearson’s r为0.83。FFRangio测量比wbFFR更快（9.6 +/- 3.4 vs. 15.0 +/- 8.9 min, p < 0.001）。结论：在MVD患者中，FFRangio与wbFFR相比具有良好的相关性和出色的诊断性能，且测量FFRangio比测量wbFFR更快。这些结果强调了在MVD患者中使用FFRangio的潜在临床益处。(c) 2019 Elsevier B.V.版权所有
Objective: To assess the performance of angiography derived Fractional Flow Reserve (FFRangio) in multivessel disease (MVD) patients undergoing angiography.Background: FFR is the reference standard for physiologic assessment of coronary stenosis and guidance of revascularization, especially in patients with MVD, yet it remains grossly underutilized. The non-wire based FFRangio performs well in non-MVD patients, but its accuracy in MVD is unknown.Methods: A prospective clinical study was conducted at Gifu Heart Centre, Japan. Patients underwent physiologic assessment of all relevant coronary lesions using wire-based FFR (wbFFR) and FFRangio. Primary outcome was diagnostic performance (sensitivity, specificity, accuracy) for FFRangio with wbFFR as reference. Other outcomes were the correlation between wbFFR/FFRangio, time required for wbFFR/FFRangio measurements, and the effect of wbFFR/FFRangio on the reclassification of coronary disease severity.Results: Fifty patients (118 lesions in total) were included. Mean age was 72 +/- 9 years, 72% were male, 36% had triple vessel disease and the average SYNTAX score was 13. The mean measurement of wbFFR and FFRangio were 0.83 +/- 0.12 and 0.81 +/- 0.11, respectively. Accuracy, sensitivity and specificity for FFRangio were 92.3% (95% CI 79.1-98.4%), 92.4% (95% CI 84.3-97.2%) and 92.4% (95% CI 87.4-97.3%), respectively. Pearson's r between wbFFR and FFRangio was 0.83. FFRangio measurement was faster than wbFFR (9.6 +/- 3.4 vs. 15.0 +/- 8.9 min, p < 0.001).Conclusions: In patients with MVD, FFRangio shows good correlation and excellent diagnostic performance compared to wbFFR, and measuring FFRangio is faster than wbFFR. These results highlight the potential clinical benefits of utilizing FFRangio among patients with MVD. (c) 2019 Elsevier B.V. All rights reserved.