Accurate understanding of the physiopathology of a coronary stenosis is a major objective in management during diagnostic coronary angiography. Measurement of fractional flow reserve(FFR) by coronary pressure measurem...Accurate understanding of the physiopathology of a coronary stenosis is a major objective in management during diagnostic coronary angiography. Measurement of fractional flow reserve(FFR) by coronary pressure measurement is a reliable method for evaluating the functional consequences of a lesion of the myocardium. This retrospective monocentric study of 114 patients showed that routine coronary pressure measurement for assessing the functional consequences of intermediate(30 to 70%stenosis) lesions or those of ambiguous topography: was necessary in 4%of diagnostic coronary angiographies enabling an immediate management decision. Using this method, 34%of complementary investigations were not performed(stress test, myocardial scintigraphy, dobutamine stress echocardiography). Seventeen per cent of unnecessary angioplasties were also avoided so that acute coronary event were also avoided when lesions with a FFR >0.75 were not treated by angioplasty. A 10-14%reduction in cost was achieved compared with a strategy of systematic angioplasty in respectively mono-or multi vessel disease patients and 39%compared with performing ambulatory myocardial scintigraphy in patients with multivessel disease.展开更多
文摘目的初步探讨血流储备分数（fractional flow reserve,FFR）在冠状动脉中度狭窄长病变中的诊治价值和右房压（right atrial pressure,RAP）对其的影响。方法共纳入我院2013年9月至2014年7月冠状动脉造影（coronary arteriography,CAG）显示至少有一支冠状动脉为中度狭窄（50%-70%）的83例住院患者,依冠状动脉病变长度分组（A组：〈20 mm,n=42;B组：20-35 mm,n=27;C组：≥36 mm,n=14）。测定FFR,并计算结合右房压计算的FFR（incorporation of right atrial pressure into the calculation of FFR,FFRrap）,比较各组间及组内的差异。FFR〈0.75,行经皮冠状动脉介入治疗（percutaneous coronary intervention,PCI）;FFR〉0.80,最佳药物治疗。FFR介于0.75-0.80之间的患者,依据FFRrap值决定治疗策略：FFRrap〈0.75,行PCI;FFRrap≥0.75则行最佳药物治疗。随访治疗后3个月内主要不良心血管事件（major adverse cardiac events,MACE）,即心源性死亡、非致死性心肌梗死、心绞痛发作情况、靶血管及靶病变再次血运重建的发生情况。结果组间比较显示：FFR和FFRrap平均值随病变长度增加均显著降低（F=2.524,P〈0.05;F=1.656,P〈0.05）;各组内结合右房压计算的FFRrap均值显著低于测定的FFR均值[A组（0.84±0.19）vs（0.78±0.14）,P〈0.05;B组（0.75±0.14）vs（0.72±0.11）,P〈0.05;C组（0.67±0.11）vs（0.63±0.07）,P〈0.05]。随访3个月内药物治疗和PCI术后MACE发生情况无明显差异,整体不良心血管事件发生率为13.3%。结论冠状动脉中度狭窄病变越长,FFR值相对偏低。当FFR介于0.75-0.80之间时,结合右房压计算的FFR能够更精确地判断病变远端的血流情况,指导临床治疗策略的选择。
文摘Accurate understanding of the physiopathology of a coronary stenosis is a major objective in management during diagnostic coronary angiography. Measurement of fractional flow reserve(FFR) by coronary pressure measurement is a reliable method for evaluating the functional consequences of a lesion of the myocardium. This retrospective monocentric study of 114 patients showed that routine coronary pressure measurement for assessing the functional consequences of intermediate(30 to 70%stenosis) lesions or those of ambiguous topography: was necessary in 4%of diagnostic coronary angiographies enabling an immediate management decision. Using this method, 34%of complementary investigations were not performed(stress test, myocardial scintigraphy, dobutamine stress echocardiography). Seventeen per cent of unnecessary angioplasties were also avoided so that acute coronary event were also avoided when lesions with a FFR >0.75 were not treated by angioplasty. A 10-14%reduction in cost was achieved compared with a strategy of systematic angioplasty in respectively mono-or multi vessel disease patients and 39%compared with performing ambulatory myocardial scintigraphy in patients with multivessel disease.
