基于血流储备分数和冠脉造影评估冠脉微血管阻力的血流动力学新方法  

Assessing coronary micro-vascular resistance by combining fractional flow reserve and invasive coronary angiography images

作　　者：陈焱 赵帅 高好考 张瑞晨 郭晓熊 李玮昊 李梓涵 廉坤 李成祥 谢辛舟 CHEN Yan;ZHAO Shuai;GAO Hao-kao;ZHANG Rui-chen;GUO Xiao-xiong;LI Wei-hao;LI Zi-han;LIAN Kun;LI Cheng-xiang;XIE Xin-zhou(Department of Cardiology,PLA Naval 971 Hospital,Qingdao 266000,Shandong,China;Department of Cardiology,Air Force Hospital of Western Theater Command,Chengdu 610000,Sichuan,China;Department of Cardiology,Xijing Hospital,Air Force Medical University,Xi’an 710032,Shaanxi,China;Department of Information Engineering,School of Electronics and Information,Northwestern Polytechnical University,Xi’an 710100,Shaanxi,China;The Primary Flight Training Base,Aviation University of Air Force,Jinzhou 121000,Liaoning,China)

机构地区：[1]中国人民解放军海军第九七一医院心血管内科,山东青岛266000 [2]西部战区空军医院心血管内科,四川成都610000 [3]空军军医大学西京医院心血管内科,陕西西安710032 [4]西北工业大学电子信息学院信息工程系,陕西西安710100 [5]空军航空大学初级飞行训练基地,辽宁锦州121000

出　　处：《心脏杂志》2024年第2期150-156,共7页Chinese Heart Journal

基　　金：空军军医大学临床研究项目(2022LC2008);西京医院临床新技术新业务(XJGX15Y39);空军军医大学教学改革研究项目(KJJYDXYB015)。

摘　　要：目的探讨一种结合血流储备分数(FFR)和冠脉造影图像评估冠状动脉微血管阻力的血流动力学新方法。方法入选2020年11月~2021年6月在空军军医大学西京医院行冠脉造影但无明显冠脉狭窄(FFR>0.8)或冠脉狭窄经PCI术治疗后FFR>0.8,且冠脉造影1月内行SPECT静息心肌灌注显像检查的患者。共纳入33例患者,35支血管。基于目标血管分区总评分(summed rest score of target vessel,SRSTV)将患者分为心肌灌注正常组(SRSTV≤1,n=21)和心肌灌注异常组(SRSTV>1,n=12)。35支血管中,SPECT静息心肌灌注正常组23支,异常组12支。通过多角度造影图像重建目标血管三维模型,基于FFR测量静息态和充血态的远近端压力,采用血流动力学方法分别计算目标血管对应血流量Q,并进一步计算微血管阻力R、归一化微循环阻力指数Rn、冠状动脉血流储备(CFR)和冠状动脉阻力储备(RRR)。比较两组间上述血流动力学参数的差异。结果两组患者年龄、性别、BMI、收缩压、舒张压、心率、住院天数、吸烟史、饮酒史、高血压、糖尿病史、心律失常史心、肌梗死史、脑血管病史、PCI史、CABG史、心血管病家族史、LVEF及用药史均无统计学差异。充血态条件下,归一化微血管阻力指数Rn在SPECT静息心肌灌注正常组和异常组间存在统计学差异,正常组显著低于异常组(P<0.01),但在静息态条件下,Rn在两组间差异不显著。其它项目两组间有数值上差异,无统计学意义。Spearman相关分析显示:微血管阻力R与SRSTV并无显著相关性,但归一化微血管阻力指数Rn在充血态与SRSTV呈现强相关关系(rho=0.602,95%CI:0.336~0.779,P<0.01),在静息态与SRSTV呈现弱相关关系(rho=0.335,95%CI:0.002~0.601,P<0.05),而CFR、RRR与SRSTV间均无显著相关性。结论在排除心外膜大血管功能学阻塞的患者中,结合FFR和冠脉造影图像的充血态归一化微循环阻力指数可很好区分心肌供血状态,为精�AIM To explore the value of a new hemodynamics method for assessing the coronary micro-vascular resistance(cMVR)by combining fractional flow reserve(FFR)and invasive coronary angiography(ICA)images.METHODS Selected patients who underwent coronary angiography at the Xijing Hospital of Air Force Military Medical University from November 2020 to June 2021 but did not have significant coronary stenosis(FFR>0.8)or had coronary stenosis treated with PCI with FFR>0.8,and underwent SPECT resting myocardial perfusion imaging within one month of coronary angiography.A total of 33 patients with 35 blood vessels were included.Based on the total rest score of target vessel(SRSTV),patients were divided into normal myocardial perfusion group(SRSTV≤1,n=21)and abnormal myocardial perfusion group(SRSTV>1,n=12).Among the 35 blood vessels,SPECT myocardial perfusion at rest was normal in 23 vessels and abnormal in 12 vessels.The three-dimensional model of the target vessel was reconstructed from multi angle angiographic images,and the far and near end pressures in Resting state fMRI and congestive states were measured based on FFR.The corresponding blood flow Q of the target vessel was calculated using hemodynamic methods,and the microvascular resistance R,normalized microcirculation resistance index Rn,coronary flow reserve(CFR)and coronary resistance reserve(RRR)were further calculated.Compare the differences in the aforementioned hemodynamic parameters between the two groups.RESULTS There was no significant difference between the two groups in age,gender,BMI,systolic blood pressure,diastolic blood pressure,heart rate,hospital stay,smoking history,drinking history,hypertension,diabetes history,arrhythmia history,heart,muscle infarction history,cerebrovascular disease history,PCI history,CABG history,cardiovascular disease family history,LVEF and medication history.Under the condition of congestive state,the normalized microvascular resistance index Rn has statistical difference between the normal and abnormal groups of SPECT rest

关 键 词：冠状动脉微血管阻力 血流动力学 

分 类 号：R541.4[医药卫生—心血管疾病]