{"title":"择期经皮冠状动脉介入治疗后病理生理疾病模式与冠状动脉绝对血流速度增加的关系","authors":"Hikaru Shimosato, Eisuke Usui, Yoshihisa Kanaji, Masahiro Hada, Tatsuhiro Nagamine, Hiroki Ueno, Mirei Setoguchi, Kodai Sayama, Takahiro Watanabe, Takashi Mineo, Nobutaka Wakasa, Taishi Yonetsu, Tetsuo Sasano, Tsunekazu Kakuta","doi":"10.1002/ccd.70122","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>Percutaneous coronary intervention (PCI) aims to restore myocardial perfusion by relieving flow-limiting lesions. While fractional flow reserve (FFR) guides PCI decision-making, the relationship between lesion pathophysiological patterns and post-PCI absolute flow improvement remains elusive. Recent evidence suggests that disease pattern—focal versus diffuse—impacts PCI outcomes. The quantitative flow ratio (QFR)-derived pullback pressure gradient (PPG) offers a wire-free method to characterize these patterns.</p>\n </section>\n \n <section>\n \n <h3> Aims</h3>\n \n <p>We investigated whether pre-PCI QFR-PPG index predicts absolute coronary flow velocity improvement, assessed by stress-transthoracic Doppler echocardiography (S-TDE), in elective PCI.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>This single-center retrospective analysis included 118 consecutive patients who underwent elective FFR-guided PCI and pre- and post-PCI LAD flow assessment using S-TDE. The study was conducted using the institutional QFR-PPG database registered in the University Hospital Medical Information Network Clinical Trials Registry (UMIN000056097). Pre-PCI QFR-PPG index was calculated to assess its association with post-PCI changes in coronary flow velocity.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Post-PCI hyperemic diastolic peak velocity (hDPV) improved in 81.3% of patients, but 18.6% showed decreased values despite FFR improvement. The median % increase in hDPV was 30.3%. Patients with greater hDPV improvement (> 30%) had significantly lower pre-PCI FFR, lower pre-PCI hDPV, and higher QFR-PPG index. Multivariable logistic regression identified these three indices as independent predictors of flow improvement. ROC analysis and net reclassification improvement (NRI) supported incremental value of the QFR-PPG index over traditional metrics.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>Pre-PCI QFR-PPG index, together with FFR and S-TDE-derived hDPV, predicts absolute flow improvement after PCI. This noninvasive, wire-free approach may help optimize revascularization decisions.</p>\n </section>\n </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"106 4","pages":"2781-2790"},"PeriodicalIF":1.9000,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Association Between Pathophysiological Disease Pattern and an Increase in Absolute Coronary Flow Velocity After Elective Percutaneous Coronary Intervention\",\"authors\":\"Hikaru Shimosato, Eisuke Usui, Yoshihisa Kanaji, Masahiro Hada, Tatsuhiro Nagamine, Hiroki Ueno, Mirei Setoguchi, Kodai Sayama, Takahiro Watanabe, Takashi Mineo, Nobutaka Wakasa, Taishi Yonetsu, Tetsuo Sasano, Tsunekazu Kakuta\",\"doi\":\"10.1002/ccd.70122\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Background</h3>\\n \\n <p>Percutaneous coronary intervention (PCI) aims to restore myocardial perfusion by relieving flow-limiting lesions. While fractional flow reserve (FFR) guides PCI decision-making, the relationship between lesion pathophysiological patterns and post-PCI absolute flow improvement remains elusive. Recent evidence suggests that disease pattern—focal versus diffuse—impacts PCI outcomes. The quantitative flow ratio (QFR)-derived pullback pressure gradient (PPG) offers a wire-free method to characterize these patterns.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Aims</h3>\\n \\n <p>We investigated whether pre-PCI QFR-PPG index predicts absolute coronary flow velocity improvement, assessed by stress-transthoracic Doppler echocardiography (S-TDE), in elective PCI.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>This single-center retrospective analysis included 118 consecutive patients who underwent elective FFR-guided PCI and pre- and post-PCI LAD flow assessment using S-TDE. The study was conducted using the institutional QFR-PPG database registered in the University Hospital Medical Information Network Clinical Trials Registry (UMIN000056097). Pre-PCI QFR-PPG index was calculated to assess its association with post-PCI changes in coronary flow velocity.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>Post-PCI hyperemic diastolic peak velocity (hDPV) improved in 81.3% of patients, but 18.6% showed decreased values despite FFR improvement. The median % increase in hDPV was 30.3%. Patients with greater hDPV improvement (> 30%) had significantly lower pre-PCI FFR, lower pre-PCI hDPV, and higher QFR-PPG index. Multivariable logistic regression identified these three indices as independent predictors of flow improvement. ROC analysis and net reclassification improvement (NRI) supported incremental value of the QFR-PPG index over traditional metrics.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusions</h3>\\n \\n <p>Pre-PCI QFR-PPG index, together with FFR and S-TDE-derived hDPV, predicts absolute flow improvement after PCI. This noninvasive, wire-free approach may help optimize revascularization decisions.</p>\\n </section>\\n </div>\",\"PeriodicalId\":9650,\"journal\":{\"name\":\"Catheterization and Cardiovascular Interventions\",\"volume\":\"106 4\",\"pages\":\"2781-2790\"},\"PeriodicalIF\":1.9000,\"publicationDate\":\"2025-08-28\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Catheterization and Cardiovascular Interventions\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1002/ccd.70122\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Catheterization and Cardiovascular Interventions","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/ccd.70122","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Association Between Pathophysiological Disease Pattern and an Increase in Absolute Coronary Flow Velocity After Elective Percutaneous Coronary Intervention
Background
Percutaneous coronary intervention (PCI) aims to restore myocardial perfusion by relieving flow-limiting lesions. While fractional flow reserve (FFR) guides PCI decision-making, the relationship between lesion pathophysiological patterns and post-PCI absolute flow improvement remains elusive. Recent evidence suggests that disease pattern—focal versus diffuse—impacts PCI outcomes. The quantitative flow ratio (QFR)-derived pullback pressure gradient (PPG) offers a wire-free method to characterize these patterns.
Aims
We investigated whether pre-PCI QFR-PPG index predicts absolute coronary flow velocity improvement, assessed by stress-transthoracic Doppler echocardiography (S-TDE), in elective PCI.
Methods
This single-center retrospective analysis included 118 consecutive patients who underwent elective FFR-guided PCI and pre- and post-PCI LAD flow assessment using S-TDE. The study was conducted using the institutional QFR-PPG database registered in the University Hospital Medical Information Network Clinical Trials Registry (UMIN000056097). Pre-PCI QFR-PPG index was calculated to assess its association with post-PCI changes in coronary flow velocity.
Results
Post-PCI hyperemic diastolic peak velocity (hDPV) improved in 81.3% of patients, but 18.6% showed decreased values despite FFR improvement. The median % increase in hDPV was 30.3%. Patients with greater hDPV improvement (> 30%) had significantly lower pre-PCI FFR, lower pre-PCI hDPV, and higher QFR-PPG index. Multivariable logistic regression identified these three indices as independent predictors of flow improvement. ROC analysis and net reclassification improvement (NRI) supported incremental value of the QFR-PPG index over traditional metrics.
Conclusions
Pre-PCI QFR-PPG index, together with FFR and S-TDE-derived hDPV, predicts absolute flow improvement after PCI. This noninvasive, wire-free approach may help optimize revascularization decisions.
期刊介绍：
Catheterization and Cardiovascular Interventions is an international journal covering the broad field of cardiovascular diseases. Subject material includes basic and clinical information that is derived from or related to invasive and interventional coronary or peripheral vascular techniques. The journal focuses on material that will be of immediate practical value to physicians providing patient care in the clinical laboratory setting. To accomplish this, the journal publishes Preliminary Reports and Work In Progress articles that complement the traditional Original Studies, Case Reports, and Comprehensive Reviews. Perspective and insight concerning controversial subjects and evolving technologies are provided regularly through Editorial Commentaries furnished by members of the Editorial Board and other experts. Articles are subject to double-blind peer review and complete editorial evaluation prior to any decision regarding acceptability.
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