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Similarity and Difference of Resting Distal to Aortic Coronary Pressure and Instantaneous Wave-Free Ratio
Journal of the American College of Cardiology ( IF 24.0 ) Pub Date : 2017-10-01 , DOI: 10.1016/j.jacc.2017.09.007
Joo Myung Lee , Jonghanne Park , Doyeon Hwang , Chee Hae Kim , Ki Hong Choi , Tae-Min Rhee , Yaliang Tong , Jin Joo Park , Eun-Seok Shin , Chang-Wook Nam , Joon-Hyung Doh , Bon-Kwon Koo

BACKGROUND Instantaneous wave-free ratio (iFR) has been used in clinical practice to identify functionally significant stenosis and to guide treatment strategy. However, there are limited clinical data regarding another resting pressure-derived index, resting distal to aortic coronary pressure (Pd/Pa), and similarities and differences between resting Pd/Pa and iFR. OBJECTIVES The authors investigated the changes in resting Pd/Pa and iFR according to anatomic and hemodynamic stenosis severity and their prognostic implications. METHODS From the 3V FFR-FRIENDS (Clinical Implication of 3-vessel Fractional Flow Reserve) and the IRIS-FFR (Study of the Natural History of FFR Guided Percutaneous Coronary Intervention) studies, 1,024 vessels (n = 435) with available pre-intervention resting Pd/Pa and iFR were used to explore the changes in resting physiological indices according to percent diameter stenosis. Among 115 patients who underwent 13N-ammonia positron emission tomography, the changes in those indices according to basal and hyperemic stenosis resistance and absolute hyperemic myocardial blood flow were compared. The association between physiological indices and the risk of 2-year major adverse cardiac events (MACE) (a composite of cardiac death, myocardial infarction, and ischemia-driven revascularization) were analyzed among 375 deferred patients. RESULTS There was a significant linear correlation between resting Pd/Pa and iFR (R = 0.970; p < 0.001, iFR = 1.370 × resting Pd/Pa - 0.370). Both resting Pd/Pa and iFR changed significantly according to percent diameter stenosis, basal and hyperemic stenosis resistance, and hyperemic absolute myocardial blood flow (all p values <0.001). Percent difference of iFR according to the increase in anatomic and hemodynamic severity was higher than that of resting Pd/Pa. Both resting Pd/Pa and iFR showed a significant association with the risk of 2-year MACE (resting Pd/Pa hazard ratio [per 0.10 increase]: 0.480; 95% confidence interval: 0.250 to 0.923; p = 0.027; iFR hazard ratio [per 0.1 increase]: 0.586; 95% confidence interval: 0.373 to 0.919; p = 0.020) in deferred patients. However, the difference between the upper- and lower-bound estimated MACE rates according to the approximate measurement variability of each index was significantly higher with resting Pd/Pa compared with iFR (resting Pd/Pa 3.85 ± 4.00% and iFR 3.27 ± 3.39%; p < 0.001). CONCLUSIONS Both resting Pd/Pa and iFR showed similar associations with anatomic and hemodynamic stenosis severity and the risk of MACE. However, iFR was more sensitive to the difference in stenosis severity and showed a lower maximum difference in estimated MACE risk influenced by the measurement variability compared with resting Pd/Pa. (Clinical Implication of 3-Vessel Fractional Flow Reserve [3V FFR-FRIENDS]; NCT01621438; and Study of the Natural History of FFR Guided Percutaneous Coronary Intervention [IRIS-FFR]; NCT01366404).

中文翻译:

静息远端冠状动脉压与瞬时无波比的异同

背景瞬时无波比(iFR)已在临床实践中用于识别功能显着的狭窄并指导治疗策略。然而,关于另一种静息压力衍生指数、静息远端冠状动脉压力 (Pd/Pa) 以及静息 Pd/Pa 和 iFR 之间的异同的临床数据有限。目标作者根据解剖和血流动力学狭窄的严重程度及其对预后的影响,研究了静息 Pd/Pa 和 iFR 的变化。方法 来自 3V FFR-FRIENDS(3 支血管血流储备分数的临床意义)和 IRIS-FFR(FFR 引导的经皮冠状动脉介入治疗的自然史研究)研究,1,024 根血管(n = 435)具有可用的干预前静息 Pd/Pa 和 iFR,用于根据直径狭窄百分比探索静息生理指标的变化。在接受 13N-氨正电子发射断层扫描的 115 名患者中,比较了根据基础和充血狭窄阻力以及绝对充血心肌血流量这些指标的变化。在 375 名延期患者中分析了生理指标与 2 年主要不良心脏事件 (MACE)(心源性死亡、心肌梗死和缺血驱动的血运重建的复合)风险之间的关联。结果静息 Pd/Pa 和 iFR 之间存在显着的线性相关性(R = 0.970;p < 0.001,iFR = 1.370 × 静息 Pd/Pa - 0.370)。静息 Pd/Pa 和 iFR 均根据直径狭窄百分比、基础和充血性狭窄阻力以及充血性绝对心肌血流量发生显着变化(所有 p 值 <0.001)。根据解剖结构和血流动力学严重程度的增加,iFR 的百分比差异高于静息 Pd/Pa。静息 Pd/Pa 和 iFR 均与 2 年 MACE 风险显着相关(静息 Pd/Pa 风险比 [每增加 0.10]:0.480;95% 置信区间:0.250 至 0.923;p = 0.027;iFR 风险比[每增加 0.1]:0.586;95% 置信区间:0.373 至 0.919;p = 0.020)在延期患者中。然而,与 iFR 相比,根据每个指标的近似测量变异性估计的上限和下限 MACE 率之间的差异显着高于 iFR(静息 Pd/Pa 3.85 ± 4.00% 和 iFR 3.27 ± 3.39%;p < 0.001)。结论 静息 Pd/Pa 和 iFR 均显示出与解剖和血流动力学狭窄严重程度以及 MACE 风险相似的关联。然而,iFR 对狭窄严重程度的差异更敏感,并且与静息 Pd/Pa 相比,受测量变异性影响的估计 MACE 风险的最大差异较低。(3 血管血流储备分数 [3V FFR-FRIENDS] 的临床意义;NCT01621438;以及 FFR 引导经皮冠状动脉介入治疗的自然史研究 [IRIS-FFR];NCT01366404)。结论 静息 Pd/Pa 和 iFR 均显示出与解剖和血流动力学狭窄严重程度以及 MACE 风险相似的关联。然而,iFR 对狭窄严重程度的差异更敏感,并且与静息 Pd/Pa 相比,受测量变异性影响的估计 MACE 风险的最大差异较低。(3 血管血流储备分数 [3V FFR-FRIENDS] 的临床意义;NCT01621438;以及 FFR 引导经皮冠状动脉介入治疗的自然史研究 [IRIS-FFR];NCT01366404)。结论 静息 Pd/Pa 和 iFR 均显示出与解剖和血流动力学狭窄严重程度以及 MACE 风险相似的关联。然而,iFR 对狭窄严重程度的差异更敏感,并且与静息 Pd/Pa 相比,受测量变异性影响的估计 MACE 风险的最大差异较低。(3 血管血流储备分数的临床意义 [3V FFR-FRIENDS];NCT01621438;和 FFR 引导经皮冠状动脉介入治疗的自然史研究 [IRIS-FFR];NCT01366404)。iFR 对狭窄严重程度的差异更敏感,与静息 Pd/Pa 相比,受测量变异性影响的估计 MACE 风险的最大差异较小。(3 血管血流储备分数的临床意义 [3V FFR-FRIENDS];NCT01621438;和 FFR 引导经皮冠状动脉介入治疗的自然史研究 [IRIS-FFR];NCT01366404)。iFR 对狭窄严重程度的差异更敏感,与静息 Pd/Pa 相比,受测量变异性影响的估计 MACE 风险的最大差异较小。(3 血管血流储备分数的临床意义 [3V FFR-FRIENDS];NCT01621438;和 FFR 引导经皮冠状动脉介入治疗的自然史研究 [IRIS-FFR];NCT01366404)。
更新日期:2017-10-01
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