摘要
目的:评估血管内超声显像(intravascularultrasound,IVUS)测定的指标对冠状动脉中度狭窄病变功能意义的判断价值。方法:46支冠状动脉造影(coronaryarteryangiography,CAG)显示中度狭窄(直径狭窄率40%~60%)的冠状动脉,压力导丝测定心肌血流储备分数(myocardialfractionalflowreserve,FFRmyo),IVUS测定面积狭窄率及最小管腔面积。以FFRmyo<0.75为界限值,采用受试者工作特征曲线(receiveroperatingcharacteristic,ROC)选择IVUS测量的每个指标的截断点。结果:46支血管病变的直径狭窄率(49±11)%,FFRmyo为(0.83±0.15),显著低于正常组(FFRmyo为0.97±0.02)。14处(30%)病变低于界限值(FFRmyo<0.75)。IVUS面积狭窄率与FFRmyo呈负相关(r=-0.68,P<0.001)。以FFRmyo<0.75为界限值,根据ROC分析,面积狭窄率≥65%为截断点,灵敏度=100%,特异性=72%。最小管腔面积与FFRmyo呈正相关(r=0.63,P<0.001),以最小管腔面积≤4mm2为截断点,灵敏度=93%,特异性=77%。结论:IVUS测定的面积狭窄率≥65%、最小管腔面积≤4mm2,能较准确地判断中度狭窄病变的功能意义。
Objective:to evaluate the role of intravascular ultrasound(IVUS) in the assessment of functional significance of the intermediate lesion. Method: In 46 lesions of intermediate severity( e. g, 40% to 60% diameter stenosis)we assessed 1. by pressure wire:myocardial fractional flow reserve(FFRmyo, index of functional significance), and 2. by IVUS: minimal lumen cross-sectional area(MLA) and percent area stenosis at the lesion site. Receiver operating characteristic(ROC) curve analysis was performed to establish the best cut-off values of IVUS indexes( i. e., MLA and percent area stenosis ) that were most predictive of FFRmyo 〈 0. 75. Result: FFRmyo in 46 lesions of angiographic intermediate stenosis (49 ± 11 )% was significantly lower than it was in angiographic normal artery (0.83 ± 0. 15 vs. 0. 97 ± 0. 02, P 〈 0. 01 ), Fourteen lesions (30%) were functionally critical ( e. g, FFRmyo 〈 0. 75 ). By regression analysis, percent area stenosis had a significant inverse correlation with FFRmyo ( r = - O. 68, P 〈 0 .O1 ) .MLA showed a significant positive relation with FFPmyo ( r = 0. 63, P 〈 0. 01 ). By ROC analysis, we identified a IVUS area stonosis ≥ 65 % (sensitivity 100%, specificity 72 % ), a minimal lumen cross-sectional area 4 mm^2 ( sensitivity 93 %, specificity 77 % ) to be the best cut-off values to fit with FFRmyo 〈 0. 75. Conclusion: IVUS area stenosis ≥ 65% and minimal lumen cross-sectional area ≥ 4 mm^2 reliably identified functionally critical intermediate coronary stenosis.
出处
《心肺血管病杂志》
CAS
2005年第3期132-135,共4页
Journal of Cardiovascular and Pulmonary Diseases