冠脉血流储备和平板运动试验在评估冠脉狭窄病变功能的价值

The Value of the Measurement of the Fractional Flow Reserve and the Treadmill Exercise Test to Evaluate of the Functional Severity of the Coronary Stenoses Lesion

目的分析冠脉血流储备功能测定和平板运动试验用于评估冠脉狭窄病变功能学影响严重性的价值。方法选择性入选2011年3月-2012年3月52例冠心病住院患者,进行运动平板试验、冠脉造影和冠脉血流储备分数(Coronary Fractional Flow Reserve简称FFR)测定。根据FFR值分为2组:A组24例FFR<0.75和B组28例FFR≥0.75,收集两组资料,随访约12个月。结果 A组24例运动平板试验均为阳性,予以植入支架治疗。在支架植入术后15分钟重复测定FFR值均高于0.75;并在介入术后第5天,A组患者重复运动平板试验结果均恢复正常。B组有25例患者运动平板试验阴性,有3例患者运动试验阳性,FFR方法可产生假阴性。所有B组患者均未进行PCI干预,而以最佳的药物治疗。28例患者临床平均随访12个月,无缺血性冠脉事件及紧急血运重建事件发生。FFR对冠脉狭窄病变功能学诊断的敏感性为88.9%,特异性为100%;阳性预测值和阴性预测值分别为100%和89.3%;其准确性为94.2%。结论 FFR是一个评估冠脉狭窄病变功能严重性值得信赖的指标。

Objective Analyses the value of the measurement of the fractional flow reserve （FFR） and the treadmill exercise test in evaluation of the functional severity of the coronary stenoses lesion. Methods The selected 52 in-patients from March 2011 to March 2012 underwent treadmill exercise test and angiography. The fractional flow reserve was also calculated during the time when the angiography was performed. According to FFR, the patients were assigned two different groups. Group A： the FFR of all 24 patients was below 0.75; Group B： the FFR of all 28 patients was 0.75 or higher. The medical information of 52 patients was collected and analyzed. The patients were followed up 12 months approximately. Results The overall 24 patients from group A had positive results of treadmill exercise test. The percutaneous coronary intervention procedure was performed and stents were implanted. The FFR was measured again 15 minutes later after the stent procedure. In every case, the value of FFR increased greater than 0.75. The treadmill exercise test was also repeated at the time of 5 days later after the percutaneous coronary intervention. The results of treadmill exercise test reverted to normal. There were 25 patients from the group B, whose results of treadmill exercise test were negative; the 3 reminds’ results of treadmill exercise test were positive. In those 3 patients, the FFR method yielded false negative outcomes. All 28 patients were treated with the optimal medical therapy and were followed up 12 months. There were no ischemic coronary events and urgent revascularization occurred. The overall sensitivity, specificity, positive, negative predictive value and accuracy for FFR to evaluate functional severity of stenoses coronary lesion are 88.9, 100, 100, 89.3 and 94.2 percent respectively. Conclusion FFR is a reliable index for evaluation the functional severity of the coronary stenoses lesion.