冠脉微循环阻力指数和冠脉血流储备分数对经皮冠状动脉介入治疗术后的功能学评估

Coronary physiological assessment combining fractional flow reserve and index of microcirculatory resistance in patients undergoing elective percutaneous coronary intervention

目的通过测定经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)术前后的冠脉血流储备分数(fractional flow reserve,FFR)、冠脉微循环阻力指数(index of microcirculatory resistance,IMR)、冠脉血流储备(coronary flow reserve,CFR)、平均传导时间(transit mean time hyperemia,Tmn)等指标评估PCI术后冠脉功能学变化。方法入选冠脉造影显示至少有单支冠状动脉主支(LAD、LCX、RCA)病变狭窄≥70%,且FFR<0.80接受PCI术患者76例。PCI术前后分别测量FFR、CFR、IMR、充血状态下平均传导时间(TmnHyp)。比较所有患者PCI术前后的Pa、Pd、TmnHyp、FFR、CFR、IMR等生理学指标。分析PCI术前各冠脉生理学指标值与PCI术后冠脉血流增加的关系。与术前TmnHyp比较,PCI术后患者血流量升高组和血流量无升高组,比较两组患者的一般临床资料、相关生化指标、心血管疾病危险因素和冠脉生理学指标。结果与PCI术前比较,术后的IMR值和TmnHyp值降低,而CFR值和FFR值明显升高(P<0.01)。多因素logistic回归分析,预测PCI术后血流增加的PCI术前IMR值为15.54、FFR值为0.61。结论经PCI术后,大部分患者的冠脉生理学指标即刻获得改善,IMR和FFR测定有助于识别PCI术后冠脉血流是否改善。

Objective Coronary functional changes after PCI were evaluated by measuring coronary blood flow reserve reserve(FFR),coronary microcirculation resistance index(IMR),coronary blood flow reserve(CFR),transit mean time(Tmn)and other indicators.Methods Seventy-six patients with coronary angiography(CAG)proved t single coronary artery main branch(left anterior descending,left circumflex or right coronary)lesion stenosis greater than 70%,and FFR<0.80 were included.Coronary flow reserve fraction(FFR),coronary flow reserve(CFR),microcirculation resistance index(IMR),transit mean time hyperemia(TmnHyp),and transit mean time base(TmnBase)were measured pre-PCI and post-PCI in all patients.Compared with the pre-TmnHyp value,patients after PCI were divided into TmnHyp-increased group and TmnHyp non-increased group.The general clinical data,related biochemical indicators,cardiovascular disease risk factors and coronary physiological indices were compared between the two groups.Results Compared with pre-PCI,post-PCI IMR was significantly reduced,TmnHyp significantly shortened,CFR significantly improved,and FFR significantly increased(P<0.01).Multivariate logistic regression analysis showed that the optimal cut-off value of pre-PCI IMR and pre-PCI FFR to predict increased coronary blood flow were 15.54 and 0.61,respectively.Conclusion The coronary physiological indices of most patients are significantly improved after PCI,and the measurement of pre-PCI IMR and pre-PCI FFR can identify whether coronary blood flow is improved.