定量冠状动脉造影和血管内超声预测左冠状动脉前降支单支病变致血流储备分数<0.80的价值

Optimized quantitative angiographic and intravascular ultrasound parameters predicting the functional significance of single de novo lesions in patients with unstable angina

目的本研究旨在针对左冠状动脉前降支(LAD)单支病变的不稳定型心绞痛(UA)患者,探讨定量冠状动脉造影(QCA)和血管内超声(IVUS)预测冠状动脉血流储备分数(FFR)<0.80的最佳临界值。方法连续入选169例LAD单支病变的患者,分别测定QCA、IVUS和FFR。使用受试者工作曲线(ROC)建立QCA和IVUS测定值预测FFR<0.80的价值。结果 99例患者(58.6%)FFR<0.80。最小管腔面积(MLA)和斑块负荷(PB)是预测FFR<0.80的两个独立因子。病变长度预测FFR<0.80的价值较小。MLA和PB预测总体LAD病变的FFR<0.80的临界值分别为3.03mm2和75.4%。MLA和PB对LAD近端(临界值分别为3.04 mm2和76.5%)及远端(临界值分别为2.82 mm2和80.6%)病变具有相似的诊断价值。联合MLA(2.82 mm2)和PB(80.6%)对于诊断远端LAD具有更大的意义。结论当病变局限在LAD时,MLA和PB预测FFR<0.80具有相似的诊断价值。联合MLA和PB对预测远端LAD病变的功能学意义具有更大的价值。

Objective The current study aimed at determine the best cutoff value of angiographic and intravascular ultrasound （ IVUS ） parameters for defining fractional flow reserve （ FFR ） 〈 O. 80 in patients with left anterior descending artery （LAD） lesion. Methods Quantitative coronary analysis, IVUS and FFR measurements were underwent in 169 patients with single LAD lesion. The best angiographic and IVUS cutoff value and their predictive value for FFR 〈 0. 80 were compared using Area under the Receiver- operator characteristic curve （AUC） in overall patients or in subgroups stratified by lesion sites. Results FFR 〈0. 80 was in 99 lesions（58. 6% ）. Minimal lumen area （MLA）, and plaque burden（PB） were two predictors of FFR 〈0. 80. Lesion length had less value in predicting FFR 〈 0. 80. The cutoff value of PB and MLA for FFR 〈 0. 80 was 75.4% and 3.03 mm2. MLA and PB had similar high diagnostic value for proximal （cutoff value 3.04 mm2 and 76. 5% ） and distal LAD lesion （2. 82 mm2 and 80. 6% ） . Combination of MLA （2. 82 mm2） and PB（80. 6% ） had increased diagnostic value for distal LAD lesion. Conclusions MLA and plaque burden had equivalent diagnostic value for FFR 〈 O. 80 when lesion localized in LAD. The predictive value of combination of MLA and plaque burden for distal LAD lesion was strengthened.