A novel method for measuring absolute coronary blood flow and microvascular resistance in patients with ischaemic heart disease.
A novel method for measuring absolute coronary blood flow and microvascular resistance in patients with ischaemic heart disease.
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DOI：
10.1093/cvr/cvaa220
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发表时间：
2021-05-25
影响因子：
10.8
通讯作者：
Gunn JP
中科院分区：
文献类型：
--
作者：
Morris PD;Gosling R;Zwierzak I;Evans H;Aubiniere-Robb L;Czechowicz K;Evans PC;Hose DR;Lawford PV;Narracott AJ;Gunn JP
缺血性心脏病是由心外膜和/或微血管疾病引起的心肌血流量减少。两者都是常见且预后重要的疾病，有明确的指导方针。分数血流储备（FFR）是目前评估心外膜冠状动脉疾病的金标准，但它只是血流的替代指标，只能预测血流变化的百分比。它不能评估绝对（容量）流量或微血管疾病。本研究的目的是开发和验证一种在导管实验室中预测冠状动脉绝对血流和微血管阻力（MVR）的新方法。计算流体动力学（CFD）模型用于预测冠状动脉绝对血流（QCFD）和冠状动脉MVR，数据来自常规有创血管造影和压力线评估。QCFD在体外血流回路中得到验证，该血流回路包含患者特异性的三维打印冠状动脉；然后在体内，对冠状动脉疾病患者。在体外，QCFD与实验流量在所有流速下都非常吻合[偏置+2.08 mL/min；95%置信区间（误差范围）−4.7 ~ +8.8 mL/min；R2 = 0.999, p < 0.001；变异系数<1%]。在体内，在基线和充血条件下，成功计算了所有40例患者的QCFD和MVR，并由此计算了冠状动脉血流储备（CFR）。qcfd衍生CFR与压力衍生CFR密切相关（R2 = 0.92, P < 0.001）。这种新方法在体外（±6.7 vs.±34 mL/min）和体内（±0.9 vs.±24.4 mmHg）均明显优于多普勒线衍生流法。在常规的导管实验室评估中，绝对冠状动脉血流和MVR可与FFR一起以绝对单位确定，无需额外的导管、导线或药物输注。利用这种新方法可以对心外膜和微血管疾病进行鉴别和量化。这种全面的冠状动脉生理评估可能使患者分层和管理达到一个新的水平。
Ischaemic heart disease is the reduction of myocardial blood flow, caused by epicardial and/or microvascular disease. Both are common and prognostically important conditions, with distinct guideline-indicated management. Fractional flow reserve (FFR) is the current gold-standard assessment of epicardial coronary disease but is only a surrogate of flow and only predicts percentage flow changes. It cannot assess absolute (volumetric) flow or microvascular disease. The aim of this study was to develop and validate a novel method that predicts absolute coronary blood flow and microvascular resistance (MVR) in the catheter laboratory. A computational fluid dynamics (CFD) model was used to predict absolute coronary flow (QCFD) and coronary MVR using data from routine invasive angiography and pressure-wire assessment. QCFD was validated in an in vitro flow circuit which incorporated patient-specific, three-dimensional printed coronary arteries; and then in vivo, in patients with coronary disease. In vitro, QCFD agreed closely with the experimental flow over all flow rates [bias +2.08 mL/min; 95% confidence interval (error range) −4.7 to +8.8 mL/min; R2 = 0.999, P < 0.001; variability coefficient <1%]. In vivo, QCFD and MVR were successfully computed in all 40 patients under baseline and hyperaemic conditions, from which coronary flow reserve (CFR) was also calculated. QCFD-derived CFR correlated closely with pressure-derived CFR (R2 = 0.92, P < 0.001). This novel method was significantly more accurate than Doppler-wire-derived flow both in vitro (±6.7 vs. ±34 mL/min) and in vivo (±0.9 vs. ±24.4 mmHg). Absolute coronary flow and MVR can be determined alongside FFR, in absolute units, during routine catheter laboratory assessment, without the need for additional catheters, wires or drug infusions. Using this novel method, epicardial and microvascular disease can be discriminated and quantified. This comprehensive coronary physiological assessment may enable a new level of patient stratification and management.
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DOI：
10.1136/heartjnl-2015-308044
发表时间：
2016-01
期刊：
Heart (British Cardiac Society)
影响因子：
--
作者：
Morris PD;Narracott A;von Tengg-Kobligk H;Silva Soto DA;Hsiao S;Lungu A;Evans P;Bressloff NW;Lawford PV;Hose DR;Gunn JP
通讯作者：
Gunn JP
影响因子：
158.5
作者：
Gotberg, M.;Christiansen, E. H.;Frobert, O.
通讯作者：
Frobert, O.
影响因子：
24
作者：
MacCarthy, P;Berger, A;De Bruyne, B
通讯作者：
De Bruyne, B
影响因子：
24
作者：
Aarnoudse, Wilbert;van't Veer, Marcel;van de Vosse, Frans
通讯作者：
van de Vosse, Frans
影响因子：
3.5
作者：
Corcoran D;Young R;Adlam D;McConnachie A;Mangion K;Ripley D;Cairns D;Brown J;Bucciarelli-Ducci C;Baumbach A;Kharbanda R;Oldroyd KG;McCann GP;Greenwood JP;Berry C
通讯作者：
Berry C