冠状动脉瞬时无波形比值联合血流储备分数在冠状动脉介入治疗中的应用

Application of instantaneous wave-free ratio combined with fractional flow reserve in percutaneous coronary intervention

目的探讨用冠状动脉内压力导丝技术测定瞬时无波形比值（i FR）联合血流储备分数（FFR）指导冠心病患者经皮冠状动脉介入治疗（PCI）的效果。方法选取冠状动脉造影提示狭窄50%~70%的冠心病患者20例,用冠状动脉内压力导丝技术测定病变血管采集i FR,给予硝酸甘油后在3 min内高速注射扩血管药物腺苷三磷酸（ATP）140μg/（kg·min）,采集高速注射ATP后的i FR（i FRATP）、FFR。计算联合应用i FR和FFR指导PCI与单纯FFR指导PCI的准确性、灵敏度、特异度、阳性预测值、阴性预测值,计算联合应用i FR和FFR指导PCI避免使用ATP患者的比例。结果本组病变血管i FR为0.9±0.1,i FRATP为0.7±0.2,两者相比P〈0.001。i FR、i FRATP与FFR呈正相关,r分别为0.68、0.91,P均〈0.001。联合应用i FR、FFR相对于单用FFR指导PCI的准确率为91.3%（21/23）、敏感度为92.3%（12/13）、特异性为90.0%（9/10）、阳性预测值为92.3%（12/13）、阴性预测值为90.0%（9/10）,并可以避免60.0%（12/20）的患者应用ATP。结论联合应用i FR和FFR指导PCI效果满意,且可以减少患者静脉应用ATP。

Objective To investigate the efficacy of using instantaneous wave-free ratio（ i FR） detected by intracoronary pressure wire combined with fractional flow reserve（ FFR） in guiding percutaneous coronary intervention（ PCI） on patients with coronary disease. Methods Twenty patients with coronary disease whose coronary arteriography showed that stenosis diameter was 50%-70% were included. The intracoronary pressure wire was used to detect the pathological vessels to collect i FR,which was treated with nitroglycerin and adenosine triphosphate（ ATP） 140 μg /（ kg·min） was added within 1-3 mins. FFR and i FR（ i FRATP） which was treated with ATP were measured. The accuracy,sensitivity,specificity,positive predictive value and negative predictive value were calculated in using i FR and PCI or only FFR in guiding PCI,and then we calculated the proportion of avoiding using ATP during the guidance of combined using of i FR and FFR.Results The i FR of pathological vessels was 0. 9 ± 0. 1,and i FRATP was 0. 7 ± 0. 2（ P〈0. 01）. i FR and i FRATP was related with FFR（ r = 0. 68,0. 91; all P〈0. 001）. The accuracy was 91. 3%（ 21 /23）,the sensitivity was 91. 3%（ 12 /13）,specificity was 90. 0%（ 9 /10）,the positive predictive value was 92. 3%（ 12 /13） and the negative predictive value was 90. 0%（ 9 /10） in the combined application of i FR and FFR during PCI as compared with the only FFR. Meanwhile,it avoided 60. 0% of the patients（ 12 /20） receiving ATP. Conclusion The combination of i FR and FFR in guiding PCI has good efficacy,and it can reduce the intravenous ATP.