Fractional Flow Reserve and Myocardial Perfusion Imaging in Patients With Angiographic Multivessel Coronary Artery Disease

被引：213

作者：

Melikian, Narbeh ^{[1
,3
]}

De Bondt, Pieter ^{[2
]}

Tonino, Pim ^{[4
]}

De Winter, Olivier ^{[2
]}

Wyffels, Eric ^{[1
]}

Bartunek, Jozef ^{[1
]}

Heyndrickx, Guy R. ^{[1
]}

Fearon, William F. ^{[5
]}

Pijls, Nico H. J. ^{[4
]}

Wijns, William ^{[1
]}

De Bruyne, Bernard ^{[1
]}

机构：

[1] OLV Clin, Cardiovasc Ctr Aalst, B-9300 Aalst, Belgium

[2] OLV Clin, Dept Nucl Med, B-9300 Aalst, Belgium

[3] Kings Coll London, British Heart Fdn Ctr Excellence, Dept Cardiol, London WC2R 2LS, England

[4] Catharina Hosp, Eindhoven, Netherlands

[5] Stanford Univ, Med Ctr, Div Cardiovasc Med, Stanford, CA 94305 USA

来源：

JACC-CARDIOVASCULAR INTERVENTIONS | 2010年 / 3卷 / 03期

关键词：

coronary revascularization; FFR; fractional flow reserve; MPI; myocardial perfusion imaging; FOLLOW-UP; PROGNOSTIC VALUE; PRESSURE MEASUREMENTS; HEART-ASSOCIATION; CLINICAL-PRACTICE; INCREMENTAL VALUE; MEDICAL THERAPY; INTERVENTION; ISCHEMIA; STENOSIS;

D O I：

10.1016/j.jcin.2009.12.010

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Objectives The aim of this study was to investigate the correlation between myocardial ischemia detected by myocardial perfusion imaging (MPI) with single-photon emission computed tomography with intracoronary pressure-derived fractional flow reserve (FFR) in patients with multivessel coronary disease at angiography. Background Myocardial perfusion imaging can underestimate the number of ischemic territories in patients with multivessel disease. However, there are limited data comparing MPI and FFR, a highly accurate functional index of myocardial ischemia, in multivessel coronary disease. Methods Sixty-seven patients (201 vascular territories) with angiographic 2- or 3-vessel coronary disease were prospectively scheduled to undergo within 2 weeks MPI (rest/stress adenosine) and FFR in each vessel. Results In 42% of patients, MPI and FFR detected identical ischemic territories (mean number of territories 0.9 +/- 0.8 for both; p = 1.00). In the remaining 36% MPI underestimated (mean number of territories; MPI: 0.46 +/- 0.6, FFR: 2.0 +/- 0.6; p <0.001) and in 22% overestimated (mean number of territories; MPI: 1.9 +/- 0.8, FFR: 0.5 +/- 0.8; p < 0.001) the number of ischemic territories in comparison with FFR. There was poor concordance between the ability of the 2 methods to detect myocardial ischemia on both a per-patient (kappa = 0.14 [95% confidence interval: -0.10 to 0.39]) and per-vessel (kappa = 0.28 [95% confidence interval: 0.15 to 0.42]) basis. Conclusions Myocardial perfusion imaging with single-photon emission computed tomography has poor concordance with FFR and tends to underestimate or overestimate the functional importance of coronary stenosis seen at angiography in comparison with FFR in patients with multivessel disease. These findings might have important consequences in using MPI to determine the optimal revascularization strategy in patients with multivessel coronary disease. (J Am Coll Cardiol Intv 2010;3:307-14) (C) 2010 by the American College of Cardiology Foundation

引用

页码：307 / 314

页数：8

共 32 条

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