阜外-FFR原理及临床应用ppt课件

.,1,FFR原理及其在不同病变中的应用价值,阜外心血管病医院冠心病诊治中心俞梦越,.,2,病变缺血,冠脉病变的解剖和功能学评价,FractionalFlowReserve,FFR,.,3,.,4,FractionalFlowReserve-FFR定义和公式假设,FFR被定义为狭窄存在和正常时心肌最大血流量（QS，QN）的比值（PaPv）（PdPv）QN,QSRRFFR=QS/QN=（Pd-Pv）/（Pa-Pv）Pd/Pa,.,5,FFR的临界值,FFR0.80提示狭窄无功能意义的敏感性90%,需要测量FFR,65%,20%,.,6,DEFERSTUDYCardiacDeathAndAcuteMIAfter5Years,3.3,7.9,15.7,0,5,10,15,20,%,P=0.20,P50%inatleast2majorcoronaryarteriesand/orintheleftmainstem”,.,14,FAMEStudy,Angiographic3-VD(n=115),造影所示三支血管病变中有功能学意义的病变血管的比例,P.ToninoetalJACC2010,.,15,MelikianN,etal.JAmCollCardiolIntv2010;3:30714,ANGIOvs.SPECTvs.FFR,SPECTvs.FFR,不同方法学对多支血管病变界定的差异,.,16,PCI的临床价值,直接PCI减少死亡，挽救生命择期PCI减轻缺血，缓解症状,.,17,IschemiaReductionImprovesOutcomes,COURAGENuclearSubstudy,ShawLJ,etal.Circulation2008;117:1283-1291,.,18,WhydoWeNeedIschemiaAssessmentintheCathLab?,50%ofpatientsundergononinvasivestresstestpriortocoronaryangiographyNoninvasivestresstestunreliableinthepresenceofmultivesselCADGenerally“territory”specific,butnot“vessel”specificCanbe“vessel”specific“butnot“lesion“specificCoronaryAngiographycannotidentifytheaccuratehemodynamicsignificanceofmanycoronarystenosis,LinGAetal.JAMA2008;300:1765-1773KernMJ.CardiolClin2011;29237267,.,19,FFR-GuidedPCIinMVD,74yearoldwomanwithHTN,hyperlipidemia,diabetesandatrialfibrillationAdmittedwithunstableanginaStressthalliumrevealedinferiorandlateralreversibleischemia,.,20,FFR=Pd/Paduringhyperemia=89/108=0.82,FFRoftheRCA,.,21,FFRLeftCircumflex,FFR=0.72,.,22,Whataboutseriallesions?,0.72,.,23,Acrossproximallesion,Acrossmiddisease,PullbackinCircumflex,Mostofgradientoccursacrossproximallesion,.,24,After“spot-stenting”proximalcircumflex,FFR=0.97,.,25,FFRinAcuteCoronarySyndromes,Non-Culprit,Culprit,.,26,Adenosinei.v.infusion140g/kg/min.,PCI:LAD,.,27,FAMETrial:Substudy:ACSversusStableAngina,FFR,ACS,N=150AngioACS,N=178,Datasuggestthatliketheoverallpopulation,a30%reductioninMACEwhenFFRisusedtoguiderevascularizationinACS,.,28,TreatmentOptionsforMVD,PCI,CABG,OMT,FAME,SYNTAX,COURAGE,.,29,FFR-guidedSYNTAXScore(FSS)versusConventionalSYNTAXScore(SS),SS,32%ofpatientsmovedtoalower-riskgroup,497patientsoftheFFR-armofFAMEISyntaxscoredre-calculatedby3incdependantreviewersFunctional(FFR)SyntaxScore:countingonlythelesionswithFFR0.80shouldbesafeandeffectiveFunctionalSYNTAXScoremayred