冠状动脉病变特征在冠状动脉功能性狭窄中的预测价值  

Predictive Value of Coronary Lesion Characteristics on Coronary Functional Stenosis

作　　者：黄蕾[1] 黄育铭 刘勇东 贾乾君[2] HUANG Lei;HUANG Yuming;LIU Yongdong;JIA Qianjun(Guangdong Provincial People's Hospital(Guangdong Academy of Medical Sciences),Southern Medical University,Guangzhou 510080,China;Department of Catheterization Lab,Guangdong Cardiovascular Institute,Guangdong Provincial Key Laboratory of South China Structural Heart Disease,Guangdong Provincial People's Hospital(Guangdong Academy of Medical Sciences),Southern Medical University,Guangzhou 510080,China)

机构地区：[1]南方医科大学附属广东省人民医院(广东省医学科学院),广州510080 [2]南方医科大学附属广东省人民医院(广东省医学科学院)心导管室,广州510080

出　　处：《岭南心血管病杂志》2024年第5期496-501,共6页South China Journal of Cardiovascular Diseases

基　　金：广东省基础与应用基础研究基金(项目编号:2022A1515010157)。

摘　　要：目的探讨冠状动脉病变特征对冠状动脉功能性狭窄的预测价值。方法回顾性分析2021年10月至2023年3月广东省人民医院收治的192例患者共计192条血管的相关数据。在接受干预措施之前,这些患者均已进行了血流储备分数(fractional flow reserve,FFR)检测,用基于默里定律的定量流量比(Murray-law quantita⁃tive flow ratio,μQFR)参数分析技术对冠状动脉病变段的特征进行评估,以FFR≤0.80定义为具有血流动力学显著性的冠状动脉缺血。结果研究结果显示,冠状动脉病变长度、直径狭窄率、微循环阻力、血流速度以及最小管腔直径在评估冠状动脉狭窄的功能性方面展现出优异的诊断效能。多因素Logistic回归模型分析结果显示,病变长度>19.39 mm[比值比(odds ratio,OR)=2.21,95%置信区间(confidence interval,CI):1.08~4.53,P=0.030]、直径狭窄率>43.7%(OR=2.16,95%CI:1.02~4.56,P=0.044)、微循环阻力≤1.91 mmHg^(*)s/m(1 mmHg=0.133 kPa)(OR=3.91,95%CI:1.89~8.10,P<0.001)、最小管腔直径≤1.78 mm(OR=2.16,95%CI:1.02~4.56,P<0.001)是冠状动脉功能性狭窄的独立影响因素。结论当无法进行FFR检测时,冠状动脉的病变长度、直径狭窄率、微循环阻力以及最小管腔直径等参数,在辨识冠状动脉功能性狭窄方面展现出了良好的预测价值。Objectives To investigate the predictive value of coronary lesion characteristics on coronary functional stenosis.Methods This study employed a retrospective analysis approach,examining relevant data of 192 patients,including totaling 192 vessels from October 2021 to March 2023 in Guangdong Provincial People's Hospital.Before undergoing intervention,these patients had undergone fractional flow reserve(FFR)testing,and the characteristics of coronary lesion segments were evaluated by using the parameter from Murray-law quantitative flow ratio(μQFR)analysis technique.In this study,FFR≤0.80 was defined as hemodynamically significant coronary ischemia.Results The study findings indicated that lesion length,diameter stenosis,microvascular resistance,blood flow velocity,and minimum lumen diameter played a good role in assessing the function of coronary stenosis.Furthermore,through the construction of a multivariate Logistic regression model,it was found that lesion length>19.39 mm[odds ratio(OR)=2.21,95%confidence interval(CI):1.08~4.53,P=0.030],diameter stenosis>43.7%(OR=2.16,95%CI:1.02~4.56,P=0.044),microvascular resistance≤1.91(mmHg^(*)s/m)(OR=3.91,95%CI:1.89~8.10,P<0.001),and minimum lumen diameter≤1.78 mm(OR=2.16,95%CI:1.02~4.56,P<0.001)were independent influencing factors for coronary functional stenosis.Conclusions When FFR testing is not feasible,parameters including coronary lesion length,diameter stenosis,microvascular resistance,and minimum lumen diameter demonstrate good predictive value in identifying coronary func‐tional stenosis.

关 键 词：冠状动脉血流动力学 冠状动脉狭窄病变 基于默里定律的定量流量比 血流储备分数 

分 类 号：R541.4[医药卫生—心血管疾病]