血流储备分数结合心脏磁共振评估冠状动脉慢性完全闭塞病变血运重建适应证初探

Evaluation of revascularization indicators in coronary chronic total occlusion lesions by ?ow reserve fraction combined with cardiac magnetic resonance

目的通过血流储备分数(FFR)和心脏磁共振(CMR)成像评估冠状动脉慢性完全闭塞(CTO)病变的血运重建适应证。方法选取2018年7月至12月四川省人民医院冠状动脉造影显示至少一支血管存在CTO病变的患者32例,通过CMR测量心肌延迟强化透壁程度和区域性室壁运动积分指数(RWMSI),比较主要供体血管和CTO病变血管在经皮冠状动脉介入治疗(PCI)前后FFR值的变化,并观察3个月随访期间左心室射血分数(LVEF)的变化情况。结果最终19例患者完成所有检查和随访。CTO-PCI后主要供体血管FFR值[(0.88±0.09)比(0.81±0.12),P=0.031]和CTO病变血管FFR值[(0.85±0.10)比(0.41±0.08),P=0.015]均较CTO-PCI前显著增加,差异均有统计学意义;3个月随访时LVEF较CTO-PCI前有所改善,差异有统计学意义[(51.32±11.72)%比(43.82±10.56)%,P=0.038]。但心肌延迟强化透壁程度>75%和RWMSI>2.0的患者CTO-PCI后FFR<0.8,LVEF无改善。结论即使有良好的侧支循环,CTO病变端心肌仍处于缺血状态。CTO-PCI后CTO病变血管和主要供体血管的FFR值均显著升高,并能带来左心功能的改善。

Objective To evaluate the indication of revascularization in patients with chronic total coronary occlusion(CTO)by flow reserve fraction(FFR)and cardiac magnetic resonance(CMR)imaging.Methods Thirty-two patients admitted to department of cardiology,Sichuan Provincial People’s Hospital from July 2018 to December 2018 with CTO lesions in at least one vessel by coronary angiography were enrolled in this study.The degree of delayed enhanced myocardial permeation and regional wall motion integral index(RWMSI)were measured by CMR.The FFR values of major donors and CTO vessels were compared before and after CTO-PCI.The left ventricular ejection fraction(LVEF)was observed at 3-month follow-up.Results Finally,19 patients completed all examinations and follow-up.After CTO-PCI,FFR of main donor vessels[(0.88±0.09)vs.(0.81±0.12),P=0.031]and CTO vessels[(0.85±0.10)vs.(0.41±0.08),P=0.015]increased significantly compared with those before CTO-PCI(P<0.05),LVEF improved significantly at 3 months follow-up compared with those before CTO-PCI[(51.32±11.72)%vs.(43.82±10.56)%,P=0.038].However,if the FFR of patients with delayed myocardial enhancement>75%and RWMSI>2.0 after CTO-PCI was less than 0.8,the LVEF did not improve.Conclusions Even with good collateral circulation,the distal myocardium of CTO is still in ischemic state.FFR values of CTO vessels and major donor vessels are signifi cantly increased after CTO-PCI,which can improve left ventricular function.