RELATION BETWEEN MYOCARDIAL FRACTIONAL FLOW RESERVE CALCULATED FROM CORONARY PRESSURE MEASUREMENTS AND EXERCISE-INDUCED MYOCARDIAL-ISCHEMIA
RELATION BETWEEN MYOCARDIAL FRACTIONAL FLOW RESERVE CALCULATED FROM CORONARY PRESSURE MEASUREMENTS AND EXERCISE-INDUCED MYOCARDIAL-ISCHEMIA
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DOI：
10.1161/01.cir.92.1.39
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发表时间：
1995-07-01
期刊：
影响因子：
37.8
通讯作者：
HEYNDRICKX, GR
中科院分区：
文献类型：
--
作者：
DEBRUYNE, B;BARTUNEK, J;HEYNDRICKX, GR
背景心肌血流储备分数（FFR（myo））是狭窄严重程度的功能性指标，可通过在最大血管舒张期间进行的冠状动脉内压力测量得出。其定义为心外膜动脉狭窄时充血期间的最大心肌灌注，表示为正常最大预期值的分数。确定充血跨病变压差的FFR（myo）阈值（Δ P-max）和静息跨病变压差（Delta P-rest），我们研究了这些压力衍生的指标和运动ECG结果之间的关系。方法和结果我们研究了60例在一个主要的心外膜冠状动脉中有孤立病变的患者，左心室功能正常，没有左心室肥大。在导管插入前6小时内进行最大运动心电图（未服用抗缺血药物）。在静息和充血期间使用压力监测导丝测量冠状动脉内压力。将峰值运动时的ST段压低（当大于或等于0.1 mV时视为异常）与FFR（myo）、Delta P-max和Delta P-rest进行比较。37例患者运动心电图异常，23例患者运动心电图正常。ST段压低幅度与FFR（myo）和Delta P-max之间存在显著线性相关性（r=-.75，SEE=0.53; r=.71，SEE=0.56）。ST段压低和Delta P-rest之间的相关性较弱（r= 0.53，SEE=0.67）。构建了三个压力衍生指数预测异常运动心电图的敏感性和特异性曲线。预测运动心电图异常的最准确值为FFR（myo）66%，Delta P-max 31 mm Hg，Delta P-rest 12 mm Hg。FFR（myo）值>72%的患者均未显示异常运动ECG。此外，受试者工作特征曲线显示了更大的准确性FFR（肌）和Δ P-max比Δ P-rest预测的结果的运动ECG.Conclusions在本研究中，截止值的FFR（肌）和translesional压力梯度之间的关系，冠状动脉内压力衍生的指标和心电图的迹象，心肌缺血在最大的运动。这些值可以帮助临床决策的情况下可疑的血管造影结果。此外，我们的数据支持充血比基础测量更好地反映狭窄生理学的概念。
Background Myocardial fractional flow reserve (FFR(myo)) is a functional index of stenosis severity that can be derived from intracoronary pressure measurements performed during maximal vasodilatation. It is defined as the maximal myocardial perfusion during hyperemia in the presence of a stenosis in the epicardial artery expressed as a fraction of its normal maximal expected value. To determine threshold values of FFR(myo), of hyperemic translesional pressure gradient (Delta P-max), and of resting translesional pressure gradient (Delta P-rest) that are uniformly associated with exercise-induced ischemia, we studied the relation between these pressure-derived indexes and the results of exercise ECG.Methods and Results We studied 60 patients with an isolated lesion in one major epicardial coronary artery, normal left ventricular function, and no left ventricular hypertrophy. Maximal exercise ECG (off anti-ischemic medication) was performed within 6 hours before catheterization. Intracoronary pressure measurements were taken at rest and during hyperemia with a pressure monitoring guide wire. ST-segment depressions at peak exercise (considered abnormal when greater than or equal to 0.1 mV) were compared with FFR(myo), Delta P-max and Delta P-rest. Thirty-seven patients had an abnormal and 23 patients a normal exercise EGG. A significant linear correlation was found be-tween the magnitude of ST-segment depressions and both FFR(myo) and Delta P-max (r=-.75, SEE=0.53; r=.71, SEE=0.56). A weaker correlation was noted between ST-segment depressions and Delta P-rest (r=.53, SEE=0.67). Sensitivity and specificity curves were constructed for the prediction of an abnormal exercise ECG for the three pressure-derived indexes. The values that most accurately predicted an abnormal exercise ECG were 66% for FFR(myo), 31 mm Hg for Delta P-max, and 12 mm Hg for Delta P-rest. No patient with a FFR(myo) value >72% showed an abnormal exercise ECG. In addition, receiver operating characteristic curves demonstrated a greater accuracy of FFR(myo) and of Delta P-max than of Delta P-rest for predicting the results of the exercise ECG.Conclusions In the present study, cut off values of FFR(myo) and translesional pressure gradients are established from the relation between intracoronary pressure-derived indexes and ECG signs of myocardial ischemia during maximal exercise. These values can be helpful for clinical decision making in cases with dubious angiographic results. Furthermore, our data support the concept that stenosis physiology is better reflected by hyperemic than by basal measurements.