血流储备分数在冠状动脉中度狭窄长病变中的应用价值及右房压对其的影响  

Value of fractional flow reserve in long lesions of coronary artery with moderate stenosis and effect of right atrial pressure on it

作　　者：王明礼[1] 刘建平[1] 钟理[1] 胡厚源[1] 迟路湘[1] 景涛[1] 李永华[1] 吕建峰[1] 王振华[1] 仝识非[1] 宋治远[1] 

机构地区：[1]第三军医大学西南医院心血管内科重庆市介入心脏病学研究所,重庆400038

出　　处：《第三军医大学学报》2014年第23期2395-2399,共5页Journal of Third Military Medical University

摘　　要：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。Objective To determine the value of fraction flow reserve（ FFR） in the diagnosis for long coronary artery lesions of with moderate stenosis and the effect of right atrial pressure（ RAP） on FFR.Methods A total of 83 patients with at least one coronary artery with moderate stenosis according to the results of coronary arteriography（ CAG） admitted in our department from September 2013 to July 2014 were recruited in this study. They were randomly divided into 3 groups based on the length of lesions,that is,group A with short lesions（ 〈 20 mm,n = 42）,group B with long lesions（ 20 to 35 mm,n = 27） and group C with super long lesions（ ≥36 mm,n = 14）. Their FFR was determined,and then recalculated by incorporation of RAP into the calculation as FFRrap. For the patients with FFR 〈 0. 75,they underwent percutaneous coronary intervention（ PCI）. For those with FFR 〉 0. 80,they only received the optimal medical therapy. For those with FFR from 0. 75 to 0. 80,PCI was carried out on the patients with FFRrap 〈 0. 75,and optimal medical therapy was given to those with FFRrap ≥ 0. 75. Major adverse cardiac events（ MACE）,such as cardiac death,nonfatal myocardial infarction,angina,revascularization of target vessel and target lesion were followed up in30 d after the therapy. Results FFR and FFRrap were significantly lower in the group C than the groups A and B（ F = 2. 524,P = 0. 000; F = 1. 656,P = 0. 015）. In every group,their FFRrap was significantly decreased than the value of FFR（ group A： 0. 84 ± 0. 19 vs 0. 78 ± 0. 14,P 〈 0. 05; group B： 0. 75 ± 0. 14 vs0. 72 ± 0. 11,P 〈 0. 05; group C： 0. 67 ± 011 vs 0. 63 ± 0. 07,P 〈 0. 05）. There was no significant difference in the incidences of MACE in different groups in 3 months after PCI or the therapy. The total incidence of MACE was 13. 3% in the cohort. Conclusion The longer the lesion of moderate coronary stenosis is,the lower the value of FFR is. When the value is from 0. 75 to 0. 80,FFRrap is more accurate to e

关 键 词：血流储备分数 冠状动脉中度狭窄 长病变 右房压 

分 类 号：R331.31[医药卫生—人体生理学] R541.4[医药卫生—基础医学]