Prognostic Implication of Thermodilution Coronary Flow Reserve in Patients Undergoing Fractional Flow Reserve Measurement

被引：56

作者：

Lee, Joo Myung ^{[1
]}

Choi, Ki Hong ^{[1
]}

Hwang, Doyeon ^{[2
,3
]}

Park, Jonghanne ^{[2
,3
,4
]}

Jung, Ji-Hyun ^{[5
]}

Kim, Hyung Yoon ^{[6
]}

Jung, Hae Won ^{[7
]}

Cho, Yun-Kyeong ^{[8
]}

Yoon, Hyuck-Jun ^{[8
]}

Song, Young Bin ^{[1
]}

Hahn, Joo-Yong ^{[1
]}

Doh, Joon-Hyung ^{[9
]}

Nam, Chang-Wook ^{[8
]}

Shin, Eun-Seok ^{[10
,11
]}

Hur, Seung-Ho ^{[8
]}

Koo, Bon-Kwon ^{[2
,3
,12
]}

机构：

[1] Sungkyunkwan Univ, Sch Med, Samsung Med Ctr, Div Cardiol,Dept Internal Med,Heart Vasc Stroke I, Seoul, South Korea

[2] Seoul Natl Univ Hosp, Dept Internal Med, 101 Daehang Ro, Seoul 110744, South Korea

[3] Seoul Natl Univ Hosp, Cardiovasc Ctr, 101 Daehang Ro, Seoul 110744, South Korea

[4] Naju Natl Hosp, Dept Internal Med, Minist Hlth & Welf, Naju, South Korea

[5] Sejong Gen Hosp, Sejong Heart Inst, Bucheon, South Korea

[6] Chonnam Natl Univ Hosp, Dept Cardiovasc Med, Gwangju, South Korea

[7] Daegu Catholic Univ, Med Ctr, Dept Cardiol, Daegu, South Korea

[8] Keimyung Univ, Dongsan Med Ctr, Dept Med, Daegu, South Korea

[9] Inje Univ, Dept Med, Ilsan Paik Hosp, Goyang, South Korea

[10] Ernst Moritz Arndt Univ Greifswald, Acad Teaching Hosp, Dietrich Bonhoeffer Hosp, Div Cardiol, Greifswald, Germany

[11] Univ Ulsan, Coll Med, Ulsan Univ Hosp, Dept Cardiol, Ulsan, South Korea

[12] Seoul Natl Univ, Inst Aging, Seoul, South Korea

来源：

JACC-CARDIOVASCULAR INTERVENTIONS | 2018年 / 11卷 / 15期

关键词：

coronary artery disease; coronary flow reserve; fractional flow reserve; myocardial ischemia; percutaneous coronary intervention; prognosis; ARTERY-DISEASE; MICROVASCULAR DYSFUNCTION; PHYSIOLOGICAL ASSESSMENT; OUTCOMES; DISCORDANCE; SEVERITY; PRESSURE; STENOSES; EVENTS;

D O I：

10.1016/j.jcin.2018.05.005

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

OBJECTIVES This study investigated the prognostic implication of coronary flow reserve (CFR) in patients who underwent fractional flow reserve (FFR) measurement. BACKGROUND Limited data are available regarding the long-term prognosis associated with thermodilution CFR in patients with coronary artery disease. METHODS A total of 519 patients (737 vessels) who did not undergo revascularization were classified according to FFR and CFR values. Low FFR and low CFR were defined with upper thresholds of 0.8 and 2.0, respectively. FFR and CFR were measured by a pressure-temperature sensor-tipped wire. Clinical outcomes were assessed by the vessel-oriented composite outcome (VOCO) (a composite of cardiac death, vessel-specific myocardial infarction, and vessel-specific revascularization) during 5 years of follow-up. RESULTS The categorical agreement (kappa = 0.080; p = 0.024) between FFR and CFR were modest, and 30.6% of the population showed discordant results between FFR and CFR. During 5 years of follow-up, patients with low CFR had a significantly higher risk of VOCO than did those with high CFR (hazard ratio [HR]: 3.171; 95% CI: 1.664 to 6.042; p < 0.001). Among patients with high FFR, there were no differences in clinical risk factor profiles, FFR, or stenosis severity between the high-CFR and low-CFR groups, and low CFR was an independent predictor for VOCO (HR: 4.999; 95% CI: 2.104 to 11.879; p < 0.001). In a 4-group classification according to both FFR and CFR, patients with low FFR and low CFR had the highest risk of VOCO (17.9%; overall p < 0.001). CONCLUSIONS Patients with low CFR had a significantly higher risk of clinical events during 5 years of follow-up. Low CFR was an independent predictor for patient-oriented composite outcome among patients with high FFR. These results support the value of CFR in patients who undergo FFR measurement. (Clinical, Physical and Prognostic Implication of Microvascular Status; NCT02186093) (C) 2018 by the American College of Cardiology Foundation.

引用

页码：1423 / 1433

页数：11

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