FFR的基本概念和技术.ppt
冠状动脉血流动力学测定冠状动脉血流动力学测定导管室的特殊运动试验导管室的特殊运动试验冠状动脉造影的补充冠状动脉造影的补充冠状动脉血流量的生理调节epicardial arterial vessels - myocardial microcirculation - venous componentPhysics Law5.05.03.03.01.01.0Coronary pressureCoronary pressureMaximum vasodilationMaximum vasodilationCoronary flowCoronary flowCoronary reserveCoronary reserve=FlowFlowdilateddilatedFlowFlowinitialinitial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 /QnmaxRstenosisRmyocardialFFRCFR CFR and rCFR: What Do They Investigate?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CFRa maybe =CFRb2 or 1.7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/PaWhy Flow (Q) = PressureEntrance effectsSeparation lossesFriction lossFFR DefinitionFFR DefinitionFFR DefinitionFRACTIONAL FLOW RESERVE:The index FFR (Fractional Flow Reserve)is based upon the two following principles: It is not resting flow, but maximum achievable flow which determines the functional capacity (exercise tolerance) of a patient At maximum vasodilation (corresponding with maximum hyperemia or with maximum exercise), blood flow to the myocardium is proportional to myocardial perfusion pressure (hyperemic distal coronary pressure) Normal Value of Myocardial Fractional Flow ReserveNormal FFR = 1 Pa PdFFR = Pa Pd0.014”3 cmPressure Monitoring Guide WiresCoronary Hyperemic StimuliPRACTICE OF CORONARY PRESSUREMEASUREMENT AND FFR （1）1. Verification of equal signals when sensor at tip of the guiding catheter. Equalization if necessary2. Advance wire, sensor crosses stenosis3. Induce maximum hyperemia and measure FFR4. Because sensor is 3 cm from tip, easily pull-back and push-up for exact spatial information.If desirable, perform pull-back recordingPRACTICE OF CORONARY PRESSUREMEASUREMENT AND FFR （2）5. PCI if indicated, with possibility for Pw measurement for collateral flow assessment6. Followed by FFR measurement to check result. If desired, perform hyperemic pull-back recording7. verify absence of drift at the end of procedure, or between measurement in several vesselsLADresting adenosine i.v.pull-back across LAD plaquehyperemic pull-back recording20010002001000Aortic Pressure = 122 mm HgAortic Pressure = 89 mm HgCoronary Pressure = 52 mm HgCoronary Pressure = 40 mm Hg P = 70 mmHG FFR = 52/122 = 0.43 FFR = 40/89 = 0.45 Influence of Systemic Pressure on Transstenotic Gradient P = 49 mmHG 1ExerciseTestThalliumScanDobut.echo0.30.40.50.60.70.80.9True Positive Stress TestsNegative Stress TestsFFR and Non-Invasive Stress Testing in Lesions of Intermediate SeverityPijls NHJ, de Bruyne B, Peels K et al. New Engl J Med 1996Ischemic Threshold Values of FFR A A Au u ut t th h ho o or r rs s s R R Re e ef f f P P Pa a at t ti i ie e en n nt t ts s s # # # T T Te e es s st t tT T Th h hr r re e es s sh h ho o ol l ld d dDe Bruyne et al.Circ 19951-VD60Bicycle ECG0.72*Pijls et al.Circ 19951-VDpre+post PCI60Bicycle ECG0.74*Pijls&De BruyneNEJM 19961-VD,Intermediate Sten45Bicycle ECG +TL+Dobut Echo0.75*Bartunek et al.JACC 19961-VD75Dobutamine Echo0.78*Chamuleau et al.JACC 2000MVD127MIBI-Spect 0.74*Abe et al.Circ 20001-VD46Thallium0.75*De Bruyne et alCirc 2001Post MI57MIBI-Spect0.75 - 0.80*冠状动脉血流动力学测定冠状动脉血流动力学测定导管室的特殊运动试验导管室的特殊运动试验打掉阻力，压力和血流成正比，打掉阻力，压力和血流成正比，压力差反应病变对血流的影响压力差反应病变对血流的影响冠状动脉造影的补充冠状动脉造影的补充Thanks
