Relationship between resting full-cycle ratio and fractional flow reserve in assessments of coronary stenosis
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摘要: 目的 确定静息全周期比值(resting full-cycle ratio，RFR)与冠状动脉(冠脉)血流储备分数(fractional flow reserve，FFR)之间一致性的预后价值，并确定测量的RFR的稳定性。方法 纳入2021年9月—2022年10月在我院接受侵入性生理学检查的患者。RFR≤0.89作为界值，FFR≤0.80作为界值，分高RFR和高FFR组(高RFR/高FFR)，高RFR和低FFR组(高RFR/低FFR)，低RFR和高FFR组(低RFR/高FFR)，低RFR和低FFR组(低RFR/低FFR)。比较RFR与FFR总的关系及各分支血管的关系，并探讨引起不一致的相关因素。结果 本研究共纳入151例患者，共205支血管。各组比例分布为高RFR和高FFR组59.5%(122/205)，高RFR和低FFR组10.7%(22/205)，低RFR和高FFR组7.3%(15/205)，低RFR和低FFR组22.4%(46/205)。RFR与FFR一致性为82.0%，并具有统计学意义(R2=0.683，P < 0.001)。RFR>0.89/FFR≤0.8不一致的预测指标中，年龄对不一致的影响具有统计学意义(OR=0.944，95%CI 0.891~0.999，P=0.047)。RFR≤0.89/FFR>0.8不一致预测指标中，女性对不一致的影响具有统计学意义(OR=5.98，95%CI 1.16~30.80，P=0.032)；LAD对不一致的影响具有统计学意义(OR=10.75，95%CI 1.38~83.70，P=0.023)。结论 RFR与FFR有很好的一致性。RFR>0.89/FFR≤0.8不一致的预测指标中，年龄对不一致的影响具有统计学意义。RFR≤0.89/FFR>0.8不一致的预测指标中，女性、LAD病变对不一致的影响具有统计学意义。
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关键词:
- 静息全周期比值 /
- 冠状动脉血流储备分数 /
- 冠状动脉介入治疗 /
- 冠心病
Abstract: Objective To identify the prognostic value of concordance between resting full-cycle ratio(RFR) and fractional flow reserve(FFR) and determine the stability of measured RFR.Methods The study included patients from September 2021 to October 2022 in our hospital and undergoing invasive physiology check and classified the data using known cutoffs for FFR(≤0.80) and RFR(≤0.89) into groups, high RFR and high FFR(high RFR/high FFR), high RFR and low FFR(high RFR/low FFR), low RFR and high FFR(low RFR/high FFR), low RFR and low FFR(low RFR/low FFR) group. The relationship between RFR and FFR and between branch vessels was compared.Results A total of 205 lesions were evaluated in 151 patients. The concordance rates in in the high RFR and high FFR group 59.5%(122/205), high RFR and low FFR group 10.7%(22/205), low RFR and high FFR group were 7.3%(15/205), low RFR and low FFR group 22.4%(46/205). The concordance between FFR and RFR was 82.0%, (R2=0.683, P < 0.001). Among the predictors of RFR>0.89/FFR≤0.8 inconsistency, age was statistically significant(OR=0.944, 95%CI 0.891-0.999, P=0.047). Among the predictors of RFR≤0.89/FFR>0.8 in consistency, female was statistically significant(OR=5.98, 95%CI 1.16-30.80, P=0.032); LAD was statistically significant(OR=10.75, 95%CI 1.38-83.70, P=0.023).Conclusion The RFR and FFR values consistently agreed. Age may be related to the difference of discordance between high RFR/low FFR. Female, LAD may be related to the difference of discordance between low RFR/high FFR. -
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表 1 患者临床基线资料
Table 1. Clinical baseline characteristics of patients
例(%), X±S, M(P25, P75) 项目 患者(151例) 年龄/岁 63.44±8.53 女性 65(43.0) BMI/(kg/m2) 25.63±2.74 高血压 89(58.9) 高脂血症 60(39.7) 糖尿病 40(26.5) 吸烟 51(33.8) 既往心梗 10(6.6) 既往PCI 12(7.9) 既往卒中 16(10.6) 心房颤动 4(2.6) 周围血管病 2(1.3) 肌酐/(mmol/L) 64.4(54.0，71.0) 不稳定型心绞痛 143(94.7) 非ST抬高心肌梗死 8(5.3) 
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表 2 患者造影特征及相关数据
Table 2. Contrast characteristics and related data of patients
支(%), M(P25, P75) 项目 病变血管(205支) 靶血管 LAD 123(60.0) LCX 31(15.1) RCA 51(24.9) 血管狭窄分组 40%~49% 3(1.5) 50%~59% 8(3.9) 60%~69% 16(7.8) ≥70% 178(86.8) RFR 0.93(0.89，0.96) RFR测量 阳性(RFR≤0.89) 61(29.8) 阴性(RFR>0.89) 144(70.2) FFR 0.85(0.77，0.90) FFR测量 阳性(FFR≤0.80) 68(33.2) 阴性(FFR>0.80) 137(66.8) 最终治疗 介入处理 64(31.2) 药物治疗 141(68.8)
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表 3 总的RFR与FFR、LAD/LCX/RCA三支血管的RFR与FFR值
Table 3. Total RFR and FFR in LAD/LCX/RCA
X±S 项目 三支血管 LAD LCX RCA P RFR 0.92±0.06 0.89±0.05 0.95±0.03 0.96±0.04 < 0.001 FFR 0.83±0.09 0.80±0.08 0.89±0.06 0.86±0.08 < 0.001
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表 4 各组不同血管RFR与FFR分布情况
Table 4. Distribution of RFR and FFR in different blood vessels
支(%) 项目 高RFR/高FFR 高RFR/低FFR 低RFR/高FFR 低RFR/低FFR 总一致性 总不一致性 总血管(205支) 122(59.5) 22(10.7) 15(7.3) 46(22.4) 168(82.0) 37(18.0) LAD(123支) 56(45.5) 14(11.4) 14(11.4) 39(31.7) 95(77.2) 28(22.8) LCX(31支) 27(87.1) 1(3.2) 0 3(9.7) 30(96.7) 1(3.2) RCA(51支) 39(76.5) 7(13.7) 1(2.0) 4(7.8) 43(84.3) 8(15.7) 非LAD(82支) 66(80.5) 8(9.8) 1(1.2) 7(8.5) 73(89.0) 9(11.0)
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表 5 高RFR/低FFR组回归分析
Table 5. Regression analysis in the high RFR/ low FFR group
因素 B 标准误 瓦尔德 自由度 显著性 Exp(B) EXP(B)的95%CI 下限 上限 年龄 -0.058 0.029 3.930 1 0.047 0.944 0.891 0.999 性别 -0.048 0.487 0.010 1 0.921 0.953 0.367 2.475 高血压 0.093 0.495 0.035 1 0.851 1.097 0.416 2.898 常量 1.933 1.913 1.021 1 0.312 6.913
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表 6 低RFR/高FFR组回归分析
Table 6. Regression analysis in the low RFR/ high FFR group
因素 B 标准误 瓦尔德 自由度 显著性 Exp(B) EXP(B)的95%CI 下限 上限 性别 1.789 0.836 4.582 1 0.032 5.985 1.163 30.802 年龄 0.067 0.046 2.121 1 0.145 1.069 0.977 1.170 高血压 0.347 0.880 0.155 1 0.693 1.415 0.252 7.945 高血脂 -18.673 7568.294 0.000 1 0.998 0.000 0.000 . 常量 -8.096 3.136 6.665 1 0.010 0.000
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表 7 低RFR/高FFR组回归分析
Table 7. Regression analysis of low RFR/ high FFR group
因素 B 标准误 瓦尔德 自由度 显著性 Exp(B) EXP(B)的95%置信区间 下限 上限 LAD 2.376 1.047 5.151 1 0.023 10.758 1.383 83.697
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