FFR的基本概念和技术课件

FFR的基本概念和技术,阜外医院,冠状动脉血流动力学测定,导管室的特殊运动试验,冠状动脉造影的补充,冠状动脉血流量的生理调节,TheCoronaryCirculation-Anatomy,epicardialarterialvessels-myocardialmicrocirculation-venouscomponent,PhysicsLaw,Klocke,FJ,MeasurementofCoronaryFlowReserve:Definingpathophysiologyversusmakingdecisionsaboutpatientcare;Circulation:1987;76:pp1183-1189,TheCoronaryCirculation-PhysiologicRegulation,生理调节的指标,CFRQsmax/Qsrest多普勒导丝测量怎么达到最大血流？打掉微循环阻力正常值有变异,冠状动脉血流量的病理调节,CFR还能达到35倍吗？它能反应病变情况吗？,不能，能，但没有特异性rCFR(RFR)=Qsmax/Qnmax,Rstenosis,Rmyocardial,FFR,CFR,CFRandrCFR:WhatDoTheyInvestigate?,一个假设病例,A：狭窄60DM微血管病变B：狭窄80没有微血管病变CFRamaybe=CFRb2or1.7,介入医生关心什么？,为介入服务完成导管室的运动试验检查病变是否有可逆缺血做研究,有没有什么更好的指标？,有FFRQsmax/Qnmax=Pd/Pa,WhyFlow(Q)=Pressure,CoronaryStenosisRheologyPressure-FlowRelationship,Pressuredropacrossstenosisincreaseswithflowinanon-linearfashion,Entranceeffects,Separationlosses,Frictionloss,FFRDefinition,FFRDefinition,FFRDefinition,FRACTIONALFLOWRESERVE:,TheindexFFR(FractionalFlowReserve)isbaseduponthetwofollowingprinciples:Itisnotrestingflow,butmaximumachievableflowwhichdeterminesthefunctionalcapacity(exercisetolerance)ofapatientAtmaximumvasodilation(correspondingwithmaximumhyperemiaorwithmaximumexercise),bloodflowtothemyocardiumisproportionaltomyocardialperfusionpressure(hyperemicdistalcoronarypressure),NormalValueofMyocardialFractionalFlowReserve,NormalFFR=1,Pa,Pd,FFR=,Pa,Pd,0.014”,3cm,PressureMonitoringGuideWires,CoronaryHyperemicStimuli,PRACTICEOFCORONARYPRESSUREMEASUREMENTANDFFR（1）,1.Verificationofequalsignalswhensensorattipoftheguidingcatheter.Equalizationifnecessary2.Advancewire,sensorcrossesstenosis3.InducemaximumhyperemiaandmeasureFFR4.Becausesensoris3cmfromtip,easilypull-backandpush-upforexactspatialinformation.Ifdesirable,performpull-backrecording,PRACTICEOFCORONARYPRESSUREMEASUREMENTANDFFR（2）,5.PCIifindicated,withpossibilityforPwmeasurementforcollateralflowassessment6.FollowedbyFFRmeasurementtocheckresult.Ifdesired,performhyperemicpull-backrecording7.verifyabsenceofdriftattheendofprocedure,orbetweenmeasurementinseveralvessels,LAD,restingadenosinei.v.,hyperemicpull-backrecording,200,100,0,200,100,0,AorticPressure=122mmHg,AorticPressure=89mmHg,CoronaryPressure=52mmHg,CoronaryPressure=40mmHg,P=70mmHG,FFR=52/122=0.43,FFR=40/89=0.45,InfluenceofSystemicPressureonTransstenoticGradient,P=49mmHG,1,ExerciseTest,ThalliumScan,Dobut.echo,0.3,0.4,0.5,0.6,0.7,0.8,0.9,TruePositiveStressTests,NegativeStressTests,FFRandNon-InvasiveStressTestinginLesionsofIntermediateSeverity,PijlsNHJ,deBruyneB,PeelsKetal.NewEnglJMed1996,IschemicThresholdValuesofFFR,A,A,A,u,u,u,t,t,t,h,h,h,o,o,o,r,r,r,s,s,s,R,R,R,e,e,e,f,f,f,P,P,P,a,a,a,t,t,t,i,i,i,e,e,e,n,n,n,t,t,t,s,s,s,#,#,#,T,T,T,e,e,e,s,s,s,t,t,t,T,T,T,h,h,h,r,r,r,e,e,e,s,s,s,h,h,h,o,o,o,l,l,l,d,d,d,DeBruyneetal.,Circ1995,1-VD,60,BicycleECG,0.72*,Pijlseta