Prevalence of myocardial perfusion scintigraphy derived ischemia in coronary lesions with discordant fractional flow reserve and non-hyperemic pressure ratios
Prevalence of myocardial perfusion scintigraphy derived ischemia in coronary lesions with discordant fractional flow reserve and non-hyperemic pressure ratios
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DOI：
10.1016/j.ijcard.2022.02.031
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发表时间：
2022-04-28
影响因子：
3.5
通讯作者：
Tanaka, Atsushi
中科院分区：
文献类型：
--
作者：
Higashioka, Daisuke;Shiono, Yasutsugu;Tanaka, Atsushi
背景资料：血流储备分数（FFR）和非充血压力比（NHPR）不一致的冠状动脉病变是否会导致心肌缺血仍不清楚。本研究调查了通过心肌灌注血流图（MPS）在FFR和瞬时无波比（iFR）不一致的冠状动脉病变中评估的心肌缺血患病率，此外，还调查了其他NHPR：静息全周期比（RFR）、舒张压比（dPR）和静息Pd/Pa。对295例稳定型冠心病患者的484支冠状动脉进行了MPS和有创生理压力测量，并将其分为四组使用FFR < 0.80、iFR < 0.89、RFR <0.89、dPR < 0.89和Pd/Pa < 0.92的相应截止值，对FFR+/NHPR+、FFR+/NHPR-、FFR-/NHPR+和FFR-/NHPR-进行了比较。结果：共175条（36%）、61条（13%）、35条（7%）和213条（44%）血管被分为FFR+/iFR+、FFR+/iFR-、FFR-/iFR+和FFR-/iFR-组。FFR+/iFR+组的MPS源性缺血比例最高（70%），其次是FFR+/iFR-组（38%）、FFR-/iFR+组（23%）和FFR-/iFR-组（10%）（P < 0.001）。当RFR时，发现MPS衍生的缺血比例相似。(70%、34%、24%和10%，P < 0.001），dPR（70%、38%、26%和10%，P < 0.001），Pd/Pa（70%、31%、22%和10%，P < 0.001）用于代替iFR。FFR和NHPR不一致的冠状动脉病变中MPS衍生心肌缺血的患病率低于FFR和NHPR一致阳性的冠状动脉病变，但高于FFR和NHPR一致阴性的冠状动脉病变。
Background: Whether a coronary lesion with discordant fractional flow reserve (FFR) and non-hyperemic pressure ratios (NHPRs) causes myocardial ischemia remains unclear. This study investigates the prevalence of myocardial ischemia as assessed by myocardial perfusion scintigraphy (MPS) in coronary lesions with discordant FFR and instantaneous wave-free ratio (iFR), and, additionally, other NHPRs: resting full-cycle ratio (RFR), diastolic pressure ratio (dPR), and resting Pd/Pa.Methods: A total of 484 coronary arteries in 295 patients with stable coronary artery disease that underwent MPS and invasive physiological pressure measurements were categorized into four groups (FFR+/NHPR+, FFR+/NHPR-, FFR-/NHPR+, and FFR-/NHPR-) using the respective cut-off values of FFR < 0.80, iFR < 0.89, RFR < 0.89, dPR < 0.89, and Pd/Pa < 0.92. The proportions of MPS-derived myocardial ischemia in a relevant myocardial territory were compared between the four groups.Results: In total, 175 (36%), 61(13%), 35(7%) and 213(44%) vessels were classified into FFR+/iFR+, FFR+/iFR-, FFR-/iFR+ and FFR-/iFR- groups, respectively. The FFR+/iFR+ group had the highest proportion of MPS-derived ischemia (70%), followed by the FFR+/iFR- group (38%), the FFR-/iFR+ group (23%), and the FFR-/iFR- group (10%) (P < 0.001). Similar proportions of MPS-derived ischemia were found when RFR. (70%, 34%, 24%, and 10%, P < 0.001), dPR (70%, 38%, 26%, and 10%, P < 0.001), and Pd/Pa (70%, 31%, 22%, and 10%, P < 0.001) were used in place of iFR.Conclusions: The prevalence of MPS-derived myocardial ischemia in coronary lesions with discordance between FFR and NHPRs is lower than those with concordantly positive FFR and NHPRs, but higher than those with concordantly negative FFR and NHPRs.