摘要
推测在冠状动脉多支血管病变(MVD)患者中,心肌灌注成像(MPI)不能检测出具有潜在心肌缺血可能性的所有血管分布区域。MPI检查基于相对血流储备,其用于判断M VD中单个部分狭窄病变意义的价值仍存质疑。血流储备分数(FFR)可以检测单个血管狭窄病变的意义。36例患者(涉及88支血管病变)接受了血管造影、FFR以及MPI。FFR是在冠状动脉内注射腺苷使之充血的情况下利用压力导丝进行测定。利用MPI进行定量分析,并将每一节段指定到特定的冠状动脉。确定每一个血管分布区域中FFR与灌注之间的关系。
We hypothesized that myocardial perfusion imaging(MPI)would fail to identify all vascular zones with the potential for myocardial ischemia in patients with multivessel coronary disease(MVD). MPI is based on the concept of relative flow reserve. The ability of these techniques to determine the significance of a particular stenosis in the setting of MVD is questionable. Fractional flow reserve(FFR) can determine the significance of individual stenoses. Thirty-six patients with disease involving 88 arteries underwent angiography, FFR, and MPI. FFR was performed using a pressure wire with hyperemia from intracoronary adenosine. Myocardial perfusion images were analyzed quantitatively and segments assigned to a specific coronary artery. The relation between FFR and perfusion was determined for each vascular zone. Of the 88 vessels, the artery was occluded(n=20) or had an abnormal FFR ≤ 0.75(n=34) in 54 of 88(61% ). MPI showed no defect in 51 zones(58% ). Concordance between angiography, FFR, and MPI was seen in 61 of 88 zones(69% ). Discordance was seen in the remaining 27 zones(31% ) and was predominantly from the finding of a FFR< 0.75 or total occlusion despite no defect on MPI. In conclusion, many patients with MVD show no perfusion defect in zones supplied by arteries with total occlusion or a FFR< 0.75. Thus, MPI underestimates ischemic burden and FFR may be better at guiding revascularization decisions than perfusion imaging in patients with MVD.
