药物涂层球囊术后定量血流分数对小血管疾病预后的预测价值

Prognostic value of quantitative flow ratio after drug-coated balloon for small-vessel disease

目的:定量血流分数(QFR)在药物涂层球囊成功治疗小血管疾病中的预测价值尚未被探索。本研究是探究术后QFR在药物涂层球囊成功治疗小血管疾病患者中的预测价值(9个月血管造影再狭窄和1年临床疗效中)。方法:回顾性分析药物涂层球囊治疗的小血管疾病患者手术前或手术后QFR值,探究其与预后的关系。主要终点是9个月时的血管造影再狭窄。次要终点是血管相关的复合终点(VOCE),定义为1年时与血管相关的心脏死亡、心肌梗死和靶血管重建。结果:共筛查出129例患者,并对所有人群进行QFR测量。其中,再狭窄35例(27.1%),VOCE 8例(6.2%)。术后血管病变处QFR对再狭窄的预测准确性中等(曲线下面积0.78,95%CI:0.67~0.88),QFR≤0.9与再狭窄风险(OR=16.66,95%CI:4.71~58.88)和VOCE(OR=6.45,95%CI:1.42~29.22)增加相关。血管扩张后QFR的预测价值较低,扩张前QFR值和前后增加值的可辨性较低甚至没有。结论:QFR在药物涂层球囊成功治疗小血管疾病预后中具有良好的预测价值,术后低病变/血管QFR值可预测造影及临床不良结局。

Objective:The prognostic value of quantitative flow ratio(QFR)measurement after DCB for de novo SVD has not been explored.The aim of this study is to investigate the value of post-procedure QFR in prediction for 9-month angiographic restenosis and 1-year clinical outcome in patients with successful drug-coated balloon(DCB)treatment on small-vessel disease(SVD).Methods:Patients completed angiographic and clinical follow-up were retrospectively analyzed for vessel and lesion pre-or post-procedure QFR.The primary outcome was angiographic binary stenosis at 9 month.The secondary endpoints was the vessel-oriented composite endpoint(VOCE),define as vessel-related cardiac death,myocardial infarction,and target vessel revascularization(TVR)at 1 year.Results:A total of 129 patients were screened and QFR was measured in all populations.Among them,binary restenosis by visual estimation occurred in 35(27.1%)and VOCE in 8(6.2%)patients.Lesion post-procedure QFR had the moderate predictive accuracy for restenosis(area under the curve,0.78,95%CI:0.67-0.88),and its value≤0.9 was associated with increased risk for restenosis(OR=16.66;95%CI:4.71-58.88)and VOCE(OR:6.45,95%CI:1.42-29.22).Vessel post-DCB QFR is less predictive,and the pre-DCB QFR and increase value had low or no discriminability.Conclusions:Patients QFR measurement after successful DCB treatment on SVD is feasible,and low post-procedure lesion or vessel QFR value could predict angiography and clinical adverse outcome.