FFR的基本概念和技術(shù)課件

FFR的基本概念和技術(shù)1冠狀動(dòng)脈血流動(dòng)力學(xué)測(cè)定導(dǎo)管室的特殊運(yùn)動(dòng)試驗(yàn)冠狀動(dòng)脈造影的補(bǔ)充2冠狀動(dòng)脈血流量的

生理調(diào)節(jié)3TheCoronaryCirculation-AnatomyAoPaPvCollateralsMyocardiumepicardialarterialvessels-myocardialmicrocirculation-venouscomponent4PhysicsLaw5Klocke,FJ,MeasurementofCoronaryFlowReserve:Definingpathophysiologyversusmakingdecisionsaboutpatientcare;Circulation:1987;76:pp1183-1189TheCoronaryCirculation-PhysiologicRegulation6生理調(diào)節(jié)的指標(biāo)CFR＝Qsmax/Qsrest多普勒導(dǎo)絲測(cè)量怎么達(dá)到最大血流？打掉微循環(huán)阻力正常值有變異7冠狀動(dòng)脈血流量的

病理調(diào)節(jié)8910111213CFR還能達(dá)到3－5倍嗎？

它能反應(yīng)病變情況嗎？不能，能，但沒(méi)有特異性rCFR(RFR)=Qsmax/Qn’max14RstenosisRmyocardialFFRCFRCFRandrCFR:WhatDoTheyInvestigate?15一個(gè)假設(shè)病例A：狹窄60％DM微血管病變B：狹窄80％沒(méi)有微血管病變CFRamaybe=CFRb＝2or1.716介入醫(yī)生關(guān)心什么？為介入服務(wù)完成導(dǎo)管室的運(yùn)動(dòng)試驗(yàn)檢查病變是否有可逆缺血做研究17有沒(méi)有什么更好的指標(biāo)？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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