Significance of Microvascular Function in Visual—Functional Mismatch Between Invasive Coronary Angiography and Fractional Flow Reserve

作者：Taishi Yonetsu, Tadashi Murai, Yoshihisa Kanaji, Tetsumin Lee, Junji Matsuda, Eisuke Usui, Masahiro Hoshino, Makoto Araki, Takayuki Niida, Masahiro Hada, Sadamitsu Ichijo, Rikuta Hamaya, Yoshinori Kanno, Tsunekazu Kakuta · 发表于：Journal of the American Heart Association · 年份：2017 · DOI：10.1161/jaha.117.005916 · 被引用次数：34 · 研究领域：Coronary Interventions and Diagnostics、Cardiac Imaging and Diagnostics、Cerebrovascular and Carotid Artery Diseases

BACKGROUND: Despite a moderate correlation between angiographical stenosis and physiological significance, the mechanism of discordance has not been fully elucidated, particularly regarding the significance of microvascular function. This study sought to clarify whether microvascular function affects visual-functional mismatch between quantitative coronary angiography (QCA) and fractional flow reserve (FFR). METHODS AND RESULTS: <0.001, respectively). Four hundred twenty-two lesions were visually nonsignificant (diameter stenosis assessed by QCA [QCA-DS] ≤50%) and 427 lesions were visually significant (QCA-DS >50%). Among visually nonsignificant lesions, FFR ≤0.80 (reverse mismatch) was observed in 129 lesions (30.6%). Among visually significant lesions, FFR >0.80 (mismatch) were observed in 179 lesions (41.9%). The significant predictors of reverse mismatch were male sex, nonculprit lesions of acute coronary syndrome, left anterior descending artery location, smaller QCA reference diameter, greater QCA-DS, lower coronary flow reserve, and lower index of microcirculatory resistance. Mismatch was associated with right coronary artery location, greater QCA reference diameter, smaller QCA-DS, lesion length, higher coronary flow reserve, and higher index of microcirculatory resistance. CONCLUSIONS: There was a high prevalence of visual-functional mismatches between QCA and FFR. The discrepancy was related to clinical characteristics, lesion-specific factors, and microvascular res...