瞬时无波形比值和血流储备分数在冠脉介入诊疗中的临床应用效果
|
摘要
目的:探讨瞬时无波形比值(iFR)和血流储备分数(FFR)在冠脉介入诊疗中的临床应用效果。方法:选取冠状动脉造影(CAG)显示至少存在1个狭窄40%～90%的病变部位的冠心病患者80例,按随机数字表法分为iFR组和FFR组,每组40例,分别行iFR、FFR检测。根据iFR、FFR结果确定冠状动脉病变的检测数量及功能性病变的数量,并指导经皮冠状动脉介入(PCI)治疗。比较两组支架置入数量、手术时间、住院费用、胸部不适及术后不良心血管事件发生率。结果:iFR组平均iFR为(0.92±0.14),FFR组平均FFR为(0.83±0.12)。iFR组冠状动脉病变的检测数量明显多于FFR组,但有显著功能性病变数量明显少于FFR组(P<0.05)。与FFR组相比,iFR组支架置入数量、住院费用明显减少,术后胸部不适发生率明显降低(P<0.05)。两组手术时间及1年内不良心血管事件发生率比较,差异均无统计学意义(均P>0.05)。结论:iFR和FFR均可用于评估冠状动脉病变情况,并指导PCI治疗,但前者诊断效能更高,更有助于减少支架植入数量,节省医疗费用。
Objective:To investigate the role of instantaneous wave-freeratio(iFR)and fractional flow reserve(FFR)in patients with coronary artery disease(CAD).Methods:Eighty CAD patients with more than one stenosis(40%-90%)were divided into iFR group and FFR group,with 40 cases in each group.The number of coronary artery lesions and functional lesions were determined according to the detection results of iFR and FFR.The number of implanted stents,operative time,hospitalization costs,and the incidence of postoperative chest discomfort and adverse cardiovascular events were compared.Results:The mean iFR in iFR group was(0.92±0.14),and the mean FFR in FFR group was(0.83±0.12).The number of coronary artery lesions in iFR group was significantly more than that in FFR group,while the number of functional lesions,the number of implanted stents and hospitalization costs were less(P<0.05).There was no significant difference between the two groups in the operative time and the incidence of adverse cardiovascular events within one year(P>0.05).Conclusion:Both iFR and FFR can be used to evaluate coronary artery lesions and guide PCI.However,the diagnostic efficiency of the former is higher,which helps to reduce the average number of implanted stents and save medical costs.
Objective:To investigate the role of instantaneous wave-freeratio(iFR)and fractional flow reserve(FFR)in patients with coronary artery disease(CAD).Methods:Eighty CAD patients with more than one stenosis(40%-90%)were divided into iFR group and FFR group,with 40 cases in each group.The number of coronary artery lesions and functional lesions were determined according to the detection results of iFR and FFR.The number of implanted stents,operative time,hospitalization costs,and the incidence of postoperative chest discomfort and adverse cardiovascular events were compared.Results:The mean iFR in iFR group was(0.92±0.14),and the mean FFR in FFR group was(0.83±0.12).The number of coronary artery lesions in iFR group was significantly more than that in FFR group,while the number of functional lesions,the number of implanted stents and hospitalization costs were less(P<0.05).There was no significant difference between the two groups in the operative time and the incidence of adverse cardiovascular events within one year(P>0.05).Conclusion:Both iFR and FFR can be used to evaluate coronary artery lesions and guide PCI.However,the diagnostic efficiency of the former is higher,which helps to reduce the average number of implanted stents and save medical costs.
引文
[1]吴善艳,贾玉柱,傅田恬.炫速双源CT冠状动脉造影的心电编辑功能在房颤患者中的应用[J].中国现代医生,2015,53(20):103-106.
[2]陈盈文,胡允兆,吴焱贤,等.血流储备分数在冠状动脉复杂病变经皮冠状动脉介入治疗中的应用[J].中国介入心脏病学杂志,2015,23(6):320-325.
[3]时学昆,程璐.血流储备分数指导冠状动脉临界病变介入治疗的作用研究[J].中国全科医学,2014,17(35):4163-4165.
[4]玄昌波,韩丽萍,潘国忠.瞬时无波形比值指导冠心病诊疗研究进展[J].中国心血管病研究,2017,15(11):964-967.
[5]MESSERLI F H,MANCIA G,CONTI C R,et al.Guid-elines on the management of stable angina pectoris:executive summary:the task force on the management of stable angina pectoris of the European society of cardiology[J].Eur Heart J,2006,27(23):2902-2903.
[6]ANDERSON J L,ADAMS C D,ANTMAN E M,et al.2011ACCF/AHA focused update incorporated into the ACC/AHA 2007guidelines for the management of patients with unstable angina/Non-ST-Elevation myocardial infarction:a report of the American college of cardiology foundation/American heart association Tas[J].Circulation,2011,123(18):e426-e579.
[7]PARK J J,PETRACO R,NAM C W,et al.Clinical validation of the resting pressure parameters in the assessment of functionally significant coronary stenosis;results of an independent,blinded comparison with fractional flow reserve[J].International Journal of Cardiology,2013,168(4):4070-4075.
[8]马跃,侯阳,乔爱科,等.冠状动脉CT血管成像模拟瞬时无波型比率评价冠状动脉功能性狭窄的初步临床研究[J].中国循环杂志,2017,32(s1):208.
[9]郭桂华,陈伟彬,张惠英.64层螺旋CT冠状动脉成像对冠脉支架置入术后支架内血管的评价[J].中国煤炭工业医学杂志,2014,17(8):1241-1243.
[10]李亚丽,侯秀伟,于爽,等.血流储备分数在冠心病介入诊疗中的应用价值[J].中国实验诊断学,2015,20(9):1604-1605.
[11]满万荣,张卫泽,孙冬冬,等.血流储备分数在冠状动脉分叉病变介入治疗中的应用[J].中华心血管病杂志,2015,43(7):642-645.
[12]GOTBERG M,FROBERT O.Instantaneous Wavefree Ratio versus Fractional Flow Reserve.[J].N Engl J Med,2017,377(16):1813-1823.
[13]陈珊珊,韩明华.血流储备分数在冠状动脉介入治疗中的应用研究[J].重庆医学,2017,46(20):2837-2839.
[14]韩雅蕾,高智强,翟东东,等.冠状动脉造影联合血流储备分数在2型糖尿病女性冠心病患者介入治疗中的应用价值[J].中国介入心脏病学杂志,2015,24(8):444-447.
[15]李勇,李文华,肖建强,等.血流储备分数在冠状动脉临界病变介入治疗中的指导作用[J].中国老年学杂志,2017,37(17):4230-4232.
[16]PETRACO R,TP V D H,NIJJER S,et al.Baseline instantaneous wave-free ratio as a pressure-only estimation of underlying coronary flow reserve:results of the JUSTIFY-CFRstudy[J].Circulation Cardiovascular Interventions,2014,7(4):492.
[17]HADJILOIZOU N,DAVIES J E,MALIK I S,et al.Differences in cardiac microcirculatory wave patterns between the proximal left mainstem and proximal right coronary artery[J].American Journal of PhysiologyHeart and Circulatory Physiology,2008,295(3):H1198.
[18]荣玉栋,蔡林.瞬时无波形比值在冠状动脉狭窄病变诊断与血运重建评估中的应用进展[J].山东医药,2017,57(15):109-111.
[19]宋光远,刘庆荣,张丽华,等.冠状动脉瞬时无波形比值联合血流储备分数在冠状动脉介入治疗中的应用[J].山东医药,2015,55(38):1-3.
[2]陈盈文,胡允兆,吴焱贤,等.血流储备分数在冠状动脉复杂病变经皮冠状动脉介入治疗中的应用[J].中国介入心脏病学杂志,2015,23(6):320-325.
[3]时学昆,程璐.血流储备分数指导冠状动脉临界病变介入治疗的作用研究[J].中国全科医学,2014,17(35):4163-4165.
[4]玄昌波,韩丽萍,潘国忠.瞬时无波形比值指导冠心病诊疗研究进展[J].中国心血管病研究,2017,15(11):964-967.
[5]MESSERLI F H,MANCIA G,CONTI C R,et al.Guid-elines on the management of stable angina pectoris:executive summary:the task force on the management of stable angina pectoris of the European society of cardiology[J].Eur Heart J,2006,27(23):2902-2903.
[6]ANDERSON J L,ADAMS C D,ANTMAN E M,et al.2011ACCF/AHA focused update incorporated into the ACC/AHA 2007guidelines for the management of patients with unstable angina/Non-ST-Elevation myocardial infarction:a report of the American college of cardiology foundation/American heart association Tas[J].Circulation,2011,123(18):e426-e579.
[7]PARK J J,PETRACO R,NAM C W,et al.Clinical validation of the resting pressure parameters in the assessment of functionally significant coronary stenosis;results of an independent,blinded comparison with fractional flow reserve[J].International Journal of Cardiology,2013,168(4):4070-4075.
[8]马跃,侯阳,乔爱科,等.冠状动脉CT血管成像模拟瞬时无波型比率评价冠状动脉功能性狭窄的初步临床研究[J].中国循环杂志,2017,32(s1):208.
[9]郭桂华,陈伟彬,张惠英.64层螺旋CT冠状动脉成像对冠脉支架置入术后支架内血管的评价[J].中国煤炭工业医学杂志,2014,17(8):1241-1243.
[10]李亚丽,侯秀伟,于爽,等.血流储备分数在冠心病介入诊疗中的应用价值[J].中国实验诊断学,2015,20(9):1604-1605.
[11]满万荣,张卫泽,孙冬冬,等.血流储备分数在冠状动脉分叉病变介入治疗中的应用[J].中华心血管病杂志,2015,43(7):642-645.
[12]GOTBERG M,FROBERT O.Instantaneous Wavefree Ratio versus Fractional Flow Reserve.[J].N Engl J Med,2017,377(16):1813-1823.
[13]陈珊珊,韩明华.血流储备分数在冠状动脉介入治疗中的应用研究[J].重庆医学,2017,46(20):2837-2839.
[14]韩雅蕾,高智强,翟东东,等.冠状动脉造影联合血流储备分数在2型糖尿病女性冠心病患者介入治疗中的应用价值[J].中国介入心脏病学杂志,2015,24(8):444-447.
[15]李勇,李文华,肖建强,等.血流储备分数在冠状动脉临界病变介入治疗中的指导作用[J].中国老年学杂志,2017,37(17):4230-4232.
[16]PETRACO R,TP V D H,NIJJER S,et al.Baseline instantaneous wave-free ratio as a pressure-only estimation of underlying coronary flow reserve:results of the JUSTIFY-CFRstudy[J].Circulation Cardiovascular Interventions,2014,7(4):492.
[17]HADJILOIZOU N,DAVIES J E,MALIK I S,et al.Differences in cardiac microcirculatory wave patterns between the proximal left mainstem and proximal right coronary artery[J].American Journal of PhysiologyHeart and Circulatory Physiology,2008,295(3):H1198.
[18]荣玉栋,蔡林.瞬时无波形比值在冠状动脉狭窄病变诊断与血运重建评估中的应用进展[J].山东医药,2017,57(15):109-111.
[19]宋光远,刘庆荣,张丽华,等.冠状动脉瞬时无波形比值联合血流储备分数在冠状动脉介入治疗中的应用[J].山东医药,2015,55(38):1-3.