| Objective:To discuss the clinical effect of myocardial microcirculation disturbance on fractional flow reserve(FFR)in patients with intermediate coronary artery lesions by measuring index of microcirculatory resistance(IMR)of these patients.Methods:From January 2019 to March 2020,60 patients in Liaoning People's Hospital with intermediate coronary artery lesions in proximal middle coronary artery and reference vessel diameter?2.5mm admitted by quantitative coronary angiography(QCA)were collected.For these patients,measuring their coronary flow reserve(CFR)?FFR?IMR and collecting their clinical and laboratory data.The patients were divided into IMR abnormal group(IMR?25)and IMR normal group(IMR<25)according to IMR measurement results.The correlation between FFR and percentage of diameter stenosis was statistically analyzed in each group,comparing the difference of FFR measurements in two groups and correlation between FFR and percentage of diameter stenosis.For the patients in IMR abnormal group,analyzing the effect of hypertension,diabetes,hyperlipidemia,smoking,creatinine,c-reactiveprotein,LVEF,criminal vessels on IMR by Logistic multi-factor regression analysis.Results:1.For all 60 patients,the average percentage of diameter stenosis was61.1±5.9%,the average FFR measurement was 0.83±0.07,the average CFR measurement was 2.68 and 0.92,and the average IMR measurement was 21.4±7.3.2.For24 cases in IMR abnormal group,16 cases are males,8 cases are females,average age is53.8±9.8.For 36 cases in IMR normal group,25 cases are males,11 cases are females,average age is 52.3±9.9.There was no significant difference in age,sex,BMI,hyperlipidemia,C-reactive protein,creatinine and lesion location between the two groups(p>0.05).The LVEF of patients in IMR abnormal group was lower than that in IMR normal group(0.48±0.06 vs.0.54±0.05,p=0.041).Hypertension(62.5% vs.33.3%,p=0.026),diabetes(62.5% vs.30.6%,p=0.014)and smoking(37.5% vs.13.9%,p=0.034)were significantly higher of the IMR abnormal group than of IMR normalgroup.3.There was no significant difference between the two groups in QCA measurements(minimum lumen diameter,the reference lumen diameter and the percentage of diameter stenosis)(p > 0.05).The FFR measurement results of IMR abnormal group was slightly higher than that of IMR normal group,and the increase was about 3.7%,but the difference was not statistically significant(0.85±0.07 vs.0.82±0.07,p=0.127).The CFR measurement results of IMR abnormal group was lower than that of IMR normal group,and the difference was statistically significant(2.32±0.65 vs.3.05±0.9,p=0.002).4.Overall FFR measurements showed a good negative correlation with the percentage of diameter stenosis(r=-0.674,p< 0.001).Both of the FFR measurement results in IMR abnormal group(r =-0.663,p <0.001)and in IMR normal group(r =-0.689,p < 0.001)showed a good negative correlation with the percentage of coronary artery diameter stenosis,but the negative correlation of IMR normal group was slightly stronger than that in IMR abnormgroup.5.According to the Logistic multi-factor regression analysis,hypertension[OR 2.612(95%CI0.956-2.678,p=0.021)],diabetes[OR 4.613(95%CI 1.212-3.233,p=0.008)],and smoking[OR 3.873(95%CI 1.587-3.546,p=0.015)] are independent risk factors for myocardial microcirculation disorders.Conclusion:1.Fractional flow reserve is a innovative index for invasive determination of epicardial blood flow function.The measurements may be influenced by some clinical factors.2.In patients with myocardial microcirculation disorder,measurements of fractional flow reserve may be slightly elevated,and its clinical significance needs further study.3.Hypertension,diabetes,and smoking are the risk factors for myocardial microcirculation disorders,and index of microcirculatory resistance should be measured simultaneously with fractional flow reserve for these patients. |
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