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Contemporary prevalence of pulmonary arterial hypertension in adult congenital heart disease following the updated clinical classification Intravascular Imaging and 12-Month Mortality After Unprotected Left Main Stem PCI: An Analysis From the British Cardiovascular Intervention Society Database Everolimus-eluting stent implantation for unprotected left main coronary artery stenosis. The PRECOMBAT-2 (Premier of Randomized Comparison of Bypass Surgery versus Angioplasty Using Sirolimus-Eluting Stent in Patients with Left Main Coronary Artery Disease) study Diagnostic Accuracy of Angiography-Based Quantitative Flow Ratio Measurements for Online Assessment of Coronary Stenosis The right ventricle in pulmonary hypertension Randomized Comparison Between Everolimus-Eluting Bioresorbable Scaffold and Metallic Stent: Multimodality Imaging Through 3 Years 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT) Use of the Instantaneous Wave-free Ratio or Fractional Flow Reserve in PCI Drug-eluting stent implantation in patients with acute coronary syndrome - the Activity of Platelets after Inhibition and Cardiovascular Events: Optical Coherence Tomography (APICE OCT) study Safety of intermediate left main stenosis revascularization deferral based on fractional flow reserve and intravascular ultrasound: A systematic review and meta-regression including 908 deferred left main stenosis from 12 studies

Original Research2014 Sep 1;84(3):406-13.

JOURNAL:Catheter Cardiovasc Interv. Article Link

Impact of myocardial supply area on the transstenotic hemodynamics as determined by fractional flow reserve

Shiono Y1 Kubo T, Tanaka A et al. Keywords: coronary angiography; fractional flow reserve; ischemic heart disease

ABSTRACT


OBJECTIVESThe aim of this study was to investigate the impact of myocardial area supplied by the coronary artery on fractional flow reserve (FFR).


BACKGROUND - Various factors other than the degree of epicardial stenosis influence the physiological significance of a coronary artery stenosis.

METHODS - A total of 296 coronary lesions in 217 patients were analyzed by quantitative coronary angiography and FFR. Myocardial area supplied by the coronary artery distal to the stenosis was evaluated by angiography using a modified version of the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) score.

RESULTS - Percent diameter stenosis of the coronary lesion was 57 ± 15% (mean ± standard deviation). FFR <0.80 was seen in 132 (45%) lesions. FFR was significantly correlated with minimum lumen diameter (r = 0.584, P <0.001), percent diameter stenosis (r = -0.565, P <0.001), lesion length (r = -0.306, P <0.001), and myocardial supply area (r = -0.504, P <0.001). Multivariate logistic analysis demonstrated that minimum lumen diameter (odds ratio [OR] = 0.031, 95% confidence interval [CI] = 0.013-0.076, P < 0.001), lesion length (OR = 1.038, 95% CI = 1.009-1.069, P = 0.001), and myocardial supply area (OR = 1.113, 95% CI = 1.079-1.147, P <0.001) were independent determinants for FFR <0.80.

CONCLUSIONS - FFR, which is the index of physiological significance of coronary artery stenosis, is influenced by myocardial supply area distal to the stenosis as well as by its own minimal lumen diameter and lesion length.

© 2013 Wiley Periodicals, Inc.