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目的探讨血管内超声(IVUS)指标结合压力导丝评价冠状动脉临界病变的价值。方法 42例患者冠状动脉造影(CAG)显示临界病变(直径狭窄率40%-70%)56处,用压力导丝测定其心肌血流储备分数(FFR),IVUS测定最小管腔面积(MLA)、血管外膜面积计算面积狭窄率。以FFR<0.75为界值,采用受试者工作特征曲线(ROC)选择IVUS指标的切点。结果 56处血管病变的IVUS测得面积狭窄率为(75.0±3.8)%,MLA(3.83±0.37)mm2。压力导丝测得FFR为0.78±0.03,29处病变低于界限值(FFR<0.75),均显著低于CAG正常对照组(FFR为0.95±0.03)。IVUS面积狭窄率与FFR呈负相关(r=-0.72,P<0.01)。以FFR<0.75为界值,根据ROC分析,面积狭窄率≥75%、MLA≤3.0mm2为切点灵敏性分别为94%、85%,特异性73%、66%。结论IVUS测定的面积狭窄率≥75%和MLA≤3.0mm2与FFR<0.75密切相关,可据此判断临界病变的血管功能,指导临床处理策略的制定。
Objective To evaluate the value of intravascular ultrasound (IVUS) combined with pressure guide wire in the evaluation of critical coronary artery disease. Methods Fifty-six coronary angiography (CAG) were performed in 56 patients with critical lesion (40% -70% diameter stenosis). The FFR was measured by pressure guidewire and the minimum lumen area (MLA) The area of vascular adventitial area was calculated as stenosis rate. Using FFR <0.75 as a cutoff point, we selected the point of IVUS index using the receiver operating characteristic curve (ROC). Results The IVUS area stenosis rates of the 56 lesions were (75.0 ± 3.8)% and MLA (3.83 ± 0.37) mm2, respectively. FFR measured by pressure guidewire was 0.78 ± 0.03, lesions at 29 sites below the threshold (FFR <0.75), significantly lower than CAG normal control group (FFR 0.95 ± 0.03). IVUS stenosis rate was negatively correlated with FFR (r = -0.72, P <0.01). According to ROC analysis, the stenosis rate of ≥ 75% and MLA ≤ 3.0 mm2 were 94%, 85%, 73%, 66% respectively, with FFR <0.75 as the cutoff value. Conclusion The stenosis rate ≥75% and MLA≤3.0mm2 determined by IVUS are closely related to FFR <0.75. Therefore, the vascular function of critical lesions can be judged and the clinical treatment strategies can be guided.