二代定量血流分数评估血管腔直径在冠状动脉支架植入术中的应用价值

Application Value of Vascular Lumen Diameter Accessed by Second-Genera⁃tion Quantitative Flow Ratio in Coronary Artery Stenting

目的探讨二代定量血流分数(quantitative flow ratio 2,QFR2)测量冠状动脉血管腔直径是否具有作为经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗中选择合适支架尺寸的参考价值。方法回顾性纳入并分析2021年2月至2021年9月在广东省人民医院行PCI治疗中有血管内超声(intravenous ultrasound,IVUS)检查的冠状动脉粥样硬化性心脏病(coronary heart disease,CHD)患者96例的资料。以PCI治疗后IVUS测量的植入支架的边缘近、远端血管腔直径为“金标准”,用QFR2、定量冠状动脉造影(quantitative coronary angi⁃ography,QCA)测量的支架边缘近、远端血管腔直径与IVUS测量的支架边缘近、远端血管腔直径进行比较,探讨QFR2测量的支架边缘近、远端血管腔直径与IVUS测量的支架边缘近、远端血管腔直径的相关性和一致性。结果96例CHD患者(100条血管,植入157枚支架)入选本研究。QFR2、QCA和IVUS测量的支架边缘近端(P=0.481)和远端(P=0.083)血管腔直径之间比较,差异无统计学意义;QFR2和IVUS测量的支架边缘近端(r=0.892,P<0.001)和远端(r=0.880,P<0.001)血管腔具有较好的相关性,其优于QCA与IVUS测量的近端(r=0.723,P<0.001)和远端(r=0.718,P<O.001)血管腔直径的相关性。QFR2测量的支架边缘近端(平均绝对差值为0.09,平均差值的95%可信区间[LOA]为-0.55~0.37)、远端(平均绝对差值为0.16,LOAs为-0.64~0.31)的血管腔直径与IVUS的一致性均优于QCA(近端平均绝对差值为0.02,LOAs为-0.83~0.78;远端平均绝对差值为0.14,LOAs为-0.96~0.69)。结论与QCA相比,QFR2在测量血管腔直径方面同IVUS具有更好的相关性和一致性。QFR2显示的血管腔直径对于帮助术者选择合适的支架尺寸具有一定的参考意义。

Objectives To investigate the role of second-generation quantitative flow ratio(QFR2)as coronary vascular lumen diameter measurements on the evaluation of appropriate stent size in percutaneous coronary intervention(PCI).Methods From February 2021 to September 2021,clinical characteristics of 96 patients with coronary heart disease(CHD)who underwent PCI and intravascular ultrasound(IVUS)in Guangdong Provincial People′s Hospital were includ-ed and retrospectively analyzed.The diameter of the proximal and distal vascular lumen of the implanted stent measured by IVUS were taken as the gold standard.The vessel lumen diameter at the proximal and distal stent edges measured by QFR2 was compared with that measured by IVUS.The correlation and consistency between the diameter of the vessel lu-men at the proximal and distal ends of the stent edge measured by QFR2 and that measured by IVUS will be studied.Results Ninety-six patients with CHD(100 vessels with 157 stents inserted)were enrolled in this study.No statistical significance had been found among the three way(QFR2,QCA and IVUS)measurements of the vessel lumen diameters at both the proximal(P=0.481)and distal(P=0.083)ends of the stent edge.In addition,the correlation of the vascular lumen diameters at both the proximal(r=0.892,P<0.001)and distal(r=0.880,P<0.001)ends of the stent edge mea-sured by QFR2 and IVUS was better than the proximal(r=0.723,P<0.001)and distal(r=0.718,P<0.001)ends of the stent edge measured by QCA and IVUS.There was a significant correlation between the vascular lumen diameters at the proximal(r=0.892,P<0.001)and distal(r=0.880,P<0.001)ends of the stent edge measured by QFR2 and IVUS.The consistency of the diameter of the proximal[the average absolute difference was 0.09,and the 95%confidence interval of the average difference with limits of agreements(LOA)was-0.55 to 0.37]and distal(the average absolute difference was 0.16,and LOAs was-0.64 to 0.31)vascular lumen measured by QFR2 was better than that of QCA(the average ab-solute difference of proximal was 0.02,LOAs was-0.83 to 0.78,and that of distal was 0.14,LOAs was-0.96 to 0.69).Conclusions QFR2 and IVUS has a good correlation compared to QCA.QFR2 has better correlation and consistency with IVUS on the vascular lumen diameter measurement.The vascular lumen diameter measured by QFR2 is more valu-able for determining the appropriate stent size.