FFR的基本概念和技术课件

FFR的基本概念和技术1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2冠状动脉血流量的

生理调节3TheCoronaryCirculation-AnatomyAoPaPvCollateralsMyocardiumepicardialarterialvessels-myocardialmicrocirculation-venouscomponent4PhysicsLaw5Klocke,FJ,MeasurementofCoronaryFlowReserve:Definingpathophysiologyversusmakingdecisionsaboutpatientcare;Circulation:1987;76:pp1183-1189TheCoronaryCirculation-PhysiologicRegulation6生理调节的指标CFR＝Qsmax/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7冠状动脉血流量的

病理调节8910111213CFR还能达到3－5倍吗？

它能反应病变情况吗？不能，能，但没有特异性rCFR(RFR)=Qsmax/Qn’max14RstenosisRmyocardialFFRCFRCFRandrCFR:WhatDoTheyInvestigate?15一个假设病例A：狭窄60％DM微血管病变B：狭窄80％没有微血管病变CFRamaybe=CFRb＝2or1.716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17有没有什么更好的指标？有FFR＝Qsmax/Qnmax=Pd/Pa18WhyFlow(Q)=Pressure19CoronaryStenosisRheologyPressure-FlowRelationshipPressuredropacrossstenosisincreaseswithflowinanon-linearfashionEntranceeffectsSeparationlossesFrictionloss20FFRDefinition21FFRDefinition22FFRDefinition23FRACTIONALFLOWRESERVE:TheindexFFR(FractionalFlowReserve)isbaseduponthetwofollowingprinciples:

Itisnotrestingflow,butmaximumachievableflowwhichdeterminesthefunctionalcapacity(exercisetolerance)ofapatientAtmaximumvasodilation(correspondingwithmaximumhyperemiaorwithmaximumexercise),bloodflowtothemyocardiumisproportionalto

myocardialperfusionpressure

(~hyperemic

distalcoronarypressure)

24NormalValueofMyocardialFractionalFlowReserveNormalFFR=1PaPdFFR

=PaPd250.014”3cmPressureMonitoringGuideWires26CoronaryHyperemicStimuli27PRACTICEOFCORONARYPRESSURE

MEASUREMENTANDFFR（1）1.Verificationofequalsignalswhensensorattipoftheguidingcatheter.Equalizationifnecessary2.Advancewire,sensorcrossesstenosis3.InducemaximumhyperemiaandmeasureFFR4.Becausesensoris3cmfromtip,easilypull-backandpush-upforexactspatialinformation.Ifdesirable,performpull-backrecording28PRACTICEOFCORONARYPRESSURE

MEASUREMENTANDFFR（2）5.PCIifindicated,withpossibilityforPwmeasurementforcollateralflowassessment6.FollowedbyFFRmeasurementtocheckresult.Ifdesired,performhyperemicpull-backrecording7.verifyabsenceofdriftattheendofprocedure,orbetweenmeasurementinseveralvessels29LADrestingadenosinei.v.30pull-backacrossLADplaquehyperemicpull-backrecording3120010002001000AorticPressure=122mmHgAorticPressure=89mmHgCoronaryPressure=52mmHgCoronaryPressure=40mmHg

ΔP=70mmHG

FFR=52/122=0.43FFR=40/89=0.45InfluenceofSystemicPressureonTransstenoticGradient

ΔP=49mmHG

321ExerciseTestThalliumScanDobut.echo0.30.40.50.60.70.80.9TruePositiveStressTestsNegativeStressTestsFFRandNon-InvasiveStressTestinginLesionsofIntermediateSeverityPijlsNHJ,deBruyneB,PeelsKetal.NewEnglJMed199633IschemicThresholdValuesofFFR

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