慢性血栓栓塞性肺动脉高压患者肺动脉血流储备的评估：一项初步研究
Evaluation of Pulmonary Artery Flow Reserve in Patients With Chronic Thromboembolic Pulmonary Hypertension: A Pilot Study.
摘要(中文译文)
压力导丝血流储备分数（FFR）可指导慢性血栓栓塞性肺动脉高压的球囊肺动脉成形术，但使用远端导丝跨越病变会增加费用和手术风险。我们开发了一种基于血管造影的生理学指标——肺动脉血流储备（PFR），通过流体动力学建模从选择性肺动脉造影中计算得出，无需推进远端压力导丝。在这项前瞻性观察性研究中，对A型（环状）、B型（网状病变）和C型（次全闭塞）肺动脉病变采集了2个投照角度的选择性肺动脉造影图像。使用压力传感器导管在靶血管开口处测量近端压力（Pa）；通过帧计数法估算血流速度；采用专有计算流体动力学方法计算压力降（ΔP），PFR推导为（Pa − ΔP）/Pa。以压力导丝FFR（Pd/Pa）作为参考标准（FFR ≤0.80）。通过受试者工作特征分析评估诊断效能，通过Bland-Altman分析评估一致性。共分析29例患者的52条血管。平均FFR和PFR分别为0.57 ± 0.23和0.58 ± 0.24；44条血管FFR ≤0.80。PFR对FFR ≤0.80显示出极好的判别能力（曲线下面积0.981，95% CI 0.935-1.000），在最佳PFR截断值0.77时，灵敏度为94.1%（95% CI 80.9%-98.7%），特异度为87.5%（95% CI 64.0%-97.0%）。一致性高（偏倚0.0076；95%一致性界限-0.1037至0.1190），相关性强（=0.970，<0.001）。在3个月随访时（n=45条血管），PFR保持高性能（曲线下面积0.985；偏倚0.0071；=0.967；均<0.001）。基于血管造影推导的PFR在慢性血栓栓塞性肺动脉高压肺动脉狭窄的生理学评估中与压力导丝FFR表现出高度一致性，可能为远端压力导丝测量提供一种更简便的替代方法，以支持生理学指导的球囊肺动脉成形术。
Abstract
Pressure-wire fractional flow reserve (FFR) can guide balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension, but lesion crossing with a distal wire increases cost and procedural risk. We developed an angiography-derived physiologic index-pulmonary artery flow reserve (PFR)-computed from selective pulmonary angiography using fluid-dynamic modeling without distal pressure-wire advancement. In this prospective observational study, selective pulmonary angiography was acquired in 2 projections for type A (ring-like), type B (web lesion) and type C (subtotal) pulmonary artery lesions. Proximal pressure (Pa) was measured at the target vessel ostium using a pressure-sensor catheter; flow velocity was estimated by frame counting; pressure drop (ΔP) was computed by a proprietary computational fluid dynamics approach, and PFR was derived as (Pa - ΔP)/Pa. Pressure-wire FFR (Pd/Pa) served as the reference standard (FFR ≤0.80). Diagnostic performance was assessed by receiver operating characteristic analysis and agreement by Bland-Altman analysis. Fifty-two vessels in 29 patients were analyzed. Mean FFR and PFR were 0.57 ± 0.23 and 0.58 ± 0.24; 44 vessels had FFR ≤0.80. PFR showed excellent discrimination for FFR ≤0.80 (area under the curve 0.981, 95% CI 0.935-1.000), with sensitivity 94.1% (95% CI 80.9%-98.7%) and specificity 87.5% (95% CI 64.0%-97.0%) at an optimal PFR cutoff of 0.77. Agreement was high (bias 0.0076; 95% limits of agreement -0.1037 to 0.1190), and correlation was strong (=0.970, <0.001). At 3-month follow-up (n=45 vessels), PFR maintained high performance (area under the curve 0.985; bias 0.0071; =0.967; all <0.001). Angiography-derived PFR demonstrated strong agreement with pressure-wire FFR for physiologic assessment of pulmonary artery stenoses in chronic thromboembolic pulmonary hypertension and may provide a simpler alternative to distal pressure-wire measurements to support physiology-guided balloon pulmonary angioplasty.
如何引用
AMA
Jinzhi Wang, Linfeng Xi, Xincao Tao, Haobo Li, Lu Sun, Zhihui Fu, et al. Evaluation of Pulmonary Artery Flow Reserve in Patients With Chronic Thromboembolic Pulmonary Hypertension: A Pilot Study.. Journal of the American Heart Association. 2026; doi:10.1161/JAHA.125.047624.
APA
Jinzhi Wang, Linfeng Xi, Xincao Tao, Haobo Li, Lu Sun, Zhihui Fu, et al (2026). Evaluation of Pulmonary Artery Flow Reserve in Patients With Chronic Thromboembolic Pulmonary Hypertension: A Pilot Study.. Journal of the American Heart Association. https://doi.org/10.1161/JAHA.125.047624
GB/T 7714
Jinzhi Wang, Linfeng Xi, Xincao Tao, Haobo Li, Lu Sun, Zhihui Fu, et al. Evaluation of Pulmonary Artery Flow Reserve in Patients With Chronic Thromboembolic Pulmonary Hypertension: A Pilot Study.[J]. Journal of the American Heart Association, 2026 doi:10.1161/JAHA.125.047624.
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