Die fraktionelle Flussreserve als Entscheidungskriterium zur Intervention bei Patienten mit 50%-igen Koronarstenosen und gestörter Myokardperfusion

Abstract

The fractional flow reserve as a criterion to intervention in patients with 50% LAD stenoses and impaired myocardial perfusionSummary Background: A fractional flow reserve (FFRmyo) < 0.75 is a well validated parameter for significance of coronary stenoses in cases of normal myocardial function. We used the FFRmyo limit in patients with impaired myocardial perfusion by myocardial infarction and/or hypertension for intermediate stenoses of the LAD for decision to PTCA and checked the indication by clinical follow-up.Methods: In 20 pts (5 women) with chest pain and visual 50 D% LAD stenoses, the FFR myo was obtained by using a RADI-PressureWire, the CFR by a densitometric technique (HODGSON), and the geometry of stenosis (minimal lumen diameter and diameter stenosis) by quantitative coronary angiography (QCA). EF and the kinetics of the anterolateral wall (expressed as radial shortening fraction) were measured by laevography.Results: The mean age of our 20 pts. was 59.4 years: 13 of the pts. (65%) had a history of hypertension, 9 (45%) pts. a history of myocardial infarction. The mean diameter stenosis was 50.8%. The mean value of CFR was 2.9. The FFR myo ranged from 0.66 to 0.90, the mean value was 0.78. The 12 pts. with FFR myo ≥ 0.75 (60%, group A) were treated with the usual antianginal medications. A PTCA was performed only in patients with FFR myo < 0.75 (N = 8 (40%), group B). Except for one pt. with instent restenosis, in the 7 pts. with denovo stenoses stent implantation was performed. Significant differences between the groups A and B were seen only for the total number of myocardial infarctions (8/12 vs. 1/8) and diameter stenosis (48.5% vs. 54.3%). All lesions of group B had a diameter stenosis of 50% or higher. CFR correlated significantly with the radial shortening fraction (r = 0.75), minimal lumen diameter (r = -0.51) and diameter stenosis (r = -0.46). FFR myo correlated with diameter stenosis (r = -0.47) only. All pts. treated with PTCA were primarily free of pain or reduced angina at least 1 CCS stage; only one developed an angina due to a restenosis (74D%) 2 months after PTCA and stent implantation. The pts. of group A did not get worse, nor were they readmitted within 6 to 13 months after catheterization.Conclusions: Pts. with 50 D% stenoses, impaired myocardial perfusion and FFR myo < 0.75 had a good long-term benefit concerning clinical and angiographic result. No pts. with FFR myo < 0.75 had a D% lower than 50; therefore, the PTCA of intermediate stenoses without quantification must be avoided. CFR is not helpful for a decision to PTCA in such cases, because a normal value of CFR is relevant only.Key words PTCAstent implantationquantitative coronary angiographyfractional flow reservecoronary flow reserve Zusammenfassung Fragestellung: Eine fraktionelle Flussreserve (FFR myo ) < 0,75 ist ein validierter Parameter für die Relevanz von Koronarstenosen, wenn die Myokardfunktion normal ist. Wir verwendeten den FFR myo -Grenzwert bei Pa-308 Zeitschrift für Kardiologie, Band 89, Heft 4 (2000) © Stein...

Intrakoronare Druckmessung - Stellenwert zur funktionellen Beurteilung von Koronarstenosen

“…Auch wenn bei Unterschreiten dieses Wertes in jedem Fall ein pathologischer Befund vorliegt, kann in Verbindung mit einer linksventrikulären Hypertrophie, bei Z.n. Infarkt im Versorgungsgebiet oder einer »small vessel disease« dieser Schwellenwert auch höher liegen (11)…”