瞬时无波形比值与血流储备分数的相关性及其影响因素

目的评价瞬时无波形比值(iFR)与血流储备分数(FFR)的相关性及影响诊断一致性的因素。方法回顾性收集北京大学第三医院2015年5月至2019年4月接受iFR和FFR检测的冠心病患者,探讨二者的相关性及影响其诊断一致性的因素。结果收集60例患者80支冠状动脉的109组FFR和iFR数据,FFR和iFR中位数分别为0.80(0.74,0.85)和0.90(0.87,0.94),二者呈线性相关(r=0.780,P<0.001)。iFR预测FFR≤0.80的受试者工作特征曲线下面积为0.870,最佳临界值为iFR≤0.90,诊断一致率为77.1%。iFR“灰区”为0.88~0.94,可使44.0%的功能学评价免予使用腺苷。体重指数是二者诊断不一致的独立影响因素,与iFR≤0.89且FFR≤0.80组相比,iFR>0.89且FFR≤0.80组的参考血管直径(3.06±0.75)mm比(2.54±0.67)mm]、最小管腔直径1.84(1.42,2.21)mm比1.35(1.17,1.52)mm]和最小管腔面积2.65(1.58,3.83)mm2比1.42(1.08,1.83)mm2]均较大(均P<0.05)。结论iFR与FFR具有良好的相关性,病变局部解剖特点可能对二者的诊断一致性产生一定影响。

The influence factors and correlation between instantaneous wave-free ratio and fractional flow reserve

Objective To evaluate the influence factors and correlation between instantaneous wavefree ratio(iFR)and fractional fl ow reserve(FFR).Methods Retrospectively collected the patients admitted to Peking University Third Hospital who received detections of iFR and FFR,evaluated the infl uence factors and correlation between them.Results A total of 109 pairs of FFR and iFR data of 80 vessels from 60 patients were collected.The median FFR was 0.80(0.74,0.85)and iFR was 0.90(0.87,0.94).There was a linear correlation between them(r=0.780,P<0.001).To predict FFR≤0.80,the area under curve(AUC)of iFR is 0.870,and the optimum critical value is iFR≤0.90,the diagnostic consistency is 77.1%.The“grey area”of iFR is 0.88–0.94,which would obviate the need for vasodilator drugs in 44.0%of detections.Body mass index(BMI)was an independent factor of the discordance between iFR and FFR.Compared with iFR≤0.89/FFR≤0.80 group,iFR>0.89/FFR≤0.80 group had larger reference diameter(3.06±0.75)mm vs.(2.54±0.67)mm],minimum lumen diameter1.84(1.42,2.21)mm vs.1.35(1.17,1.52)mm]and minimum lumen area2.65(1.58,3.83)mm2 vs.1.42(1.08,1.83)mm2](all P<0.05).Conclusions iFR and FFR have a good correlation,and the local anatomical parameters of lesions might infl uence the consistency between them.