FFR血流储备分数_2.ppt

血流储备分数FFR测量系统 FFR= 冠脉 “Measurement of Fractional Flow Reserve to assess the functional severity of coronary artery stenosis” -1996, Nico Pijls 背景： 冠脉中度狭窄的临床意义很难确定。心肌血流储备分数（FFR)是一个评价冠脉狭窄的功能学指标。FFR和常规使用的无创生理学检查指标相比较，以检查心肌缺血。 方法： 在45个冠脉中度狭窄，不明原因胸痛的患者中，踏车运动实验，动静态核素心肌显像（thallium scintigraphy），超声心动图多巴酚丁胺试验（DSE， dobutamine stress echocardiography），血管造影和FFR测量相比较。 冠脉压力测量的必备条件： FFR可以给介入医生的在制定患者治疗策略时提供更多信息和依据，因为： 血管造影术本身的局限性 形态学和功能学的差异 无创评估指标的局限性 不加选择的使用DES的潜在不利因素 PressureWire压力导丝的优越性能，使准确、可靠测量FFR成为可能。 FFR-被称为是导管室内的“运动实验” FFR现在已经在ACC/AHA/SCAI Guidelines on PCI提升到 Class:IIa(size of treatment effect):Benefit Risk, reasonable Level of evidence:A(Estimate of Certainty of treatment effect)Highest。 Notes: The slides in this presentation are intended to illustrate the following: Defining the significance of a given CSA (lumen cross sectional area) by IVUS is dependant on the normal size of the artery which varies considerably from one artery to another and from one person to another. FFR is a relative index that takes into account the size of the person and the size of the vessel. Physiologic stenosis severity cannot be judged without taking into account the perfusion area.IVUS is only a picture of the vessel and does not tell us about the needs of the perfusion area supplied by the vessel. FFR is a relative index that takes into account size of perfusion area. - Collaterals modify physiologic stenosis severity. IVUS does not tell us how much collaterals contribute to supplying the myocardium. FFR is a relative index that takes into account collateral function. - An increase or decrease in the severity of one lesion will modify the physiologic stenosis severity of other lesions in series. IVUS is only a picture, and the picture of one stenosis will not change if another stenosis in the same vessel is stented. FFR for an entire vessel may very well change before and after stenting of one stenosis in series because in a series, one stenosis affects a