冠脉内压力导丝测定静息Pd/Pa值可以预测血流储备分数

目的探讨静息状态下冠脉狭窄远端压力与主动脉根部或冠脉口部压力的比值（Pd/Pa）与血流储备分数（FFR）之间的关系。方法回顾性分析在北京大学第三医院住院的84例患者中接受冠脉内压力导丝评估的103处病变的数据。多体位选择性冠脉造影,QCA评价病变直径狭窄程度。结果静息Pd/Pa值与FFR具有线性相关性（r=0.78;P〈0.0001）,以FFR值≤0.75来定义为缺血临界值时,当静息Pd/Pa≤0.86时,其预测缺血的阳性预测值可达95%,而当Pd/Pa值≥0.93时,其预测缺血阴性的预测值也达95%。结论静息Pd/Pa值与FFR具有明显的相关性,通过静息Pd/Pa值预测FFR缺血界值具有较高的阳性和阴性预测值,这提示在压力-病变功能评估中部分患者能够避免使用腺苷等微循环扩张剂,达到减少药物相关反应和手术过程的目的 。

Resting Pd/Pa measured with intracoronary pressure wire can predict fractional flow reserve

Objective To investigate the relationship between ratio（Pd/Pa）of resting distal coronary pressure to aortic pressure and fractional flow reserve（FFR）obtained during maximal hyperemia.Methods One hundren and three lesions with pressure-wire studies performed in 84 patients were retrospectively analyzed.Results A linear correlation between resting Pd/Pa and FFR post-pharmacological hyperemia was observed（r=0.78;P0.0001）.When a FFR of ≤0.75 was defined as a cut-off value of ischemia,a resting Pd/Pa of ≤0.86 had a positive predictive value（PPV）of 95%,while a resting Pd/Pa of ≥0.93 had a negative predictive value（NPV）of 95%.Conclusions We demonstrate a strong correlation between resting Pd/Pa and FFR.Resting values of Pd/Pa can be used to predict the cut-off value of ischemia of FFR with relatively high PPV and NPV.This may potentially obviate the need for adenosine or other hyperemia agents infusion in a proportion of pressure-wire studies,reduce adverse reactions of drugs and shorten the process of operation.