FFR的基本概念和技术.pptx

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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第1页/共36页冠状动脉血流量的生理调节第2页/共36页The Coronary Circulation-AnatomyAoAoP Pa aP Pv vCollateralsCollateralsMyocardiumMyocardiumepicardial arterial vessels-myocardial microcirculation-venous component第3页/共36页Physics Law第4页/共36页Klocke,FJ,Measurement of Coronary Flow Reserve:Defini

2、ng Klocke,FJ,Measurement of Coronary Flow Reserve:Defining pathophysiology versus making decisions about patient care;pathophysiology versus making decisions about patient care;CirculationCirculation:1987;76:pp 1183-1189:1987;76:pp 1183-1189The Coronary Circulation-Physiologic RegulationThe Coronary

3、 Circulation-Physiologic Regulation第5页/共36页生理调节的指标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第6页/共36页冠状动脉血流量的病理调节第7页/共36页第8页/共36页第9页/共36页第10页/共36页第11页/共36页第12页/共36页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第13页/共36页RstenosisRmyocardialFFRCFR CFR and rCFR:What Do They Investigate?第14页/共

4、36页一个假设病例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第15页/共36页介入医生关心什么？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第16页/共36页有没有什么更好的指标？有FFRQsmax/Qnmax=Pd/Pa第17页/共36页Why Flow(Q)=Pressure第18页/共36页Coronary Stenosis RheologyPressure-Flow RelationshipPressure-Flow RelationshipPressure drop across stenosis increa

5、ses with flow in a non-linear fashionPressure drop across stenosis increases with flow in a non-linear fashionEntrance effectsSeparation lossesFriction loss第19页/共36页FFR Definition第20页/共36页FFR Definition第21页/共36页FFR Definition第22页/共36页FRACTIONAL FLOW RESERVE:The index FFR(Fractional Flow Reserve)is b

6、ased 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 my

7、ocardial perfusion pressure (hyperemic distal coronary pressure)第23页/共36页 Normal Value of Myocardial Fractional Flow ReserveNormal FFR =1 Pa PdFFR =Pa Pd第24页/共36页0.014”3 cmPressure Monitoring Guide Wires第25页/共36页Coronary Hyperemic Stimuli第26页/共36页PRACTICE OF CORONARY PRESSUREMEASUREMENT AND FFR（1）1.

8、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-bac

9、k recording第27页/共36页PRACTICE 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,

10、or between measurement in several vessels第28页/共36页LADresting adenosine i.v.第29页/共36页pull-back across LAD plaquehyperemic pull-back recording第30页/共36页20010002001000Aortic 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

11、=0.45 Influence of Systemic Pressure on Transstenotic Gradient P=49 mmHG 第31页/共36页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

12、 J Med 1996第32页/共36页Ischemic 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 PCI60Bic

13、ycle 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*100%Specificity;*Optimal Cutoff Value*100%Specificity;*Optimal Cutoff Value0.750.75第33页/共36页冠状动脉血流动力学测定导管室的特殊运动试验打掉阻力，压力和血流成正比，压力差反应病变对血流的影响冠状动脉造影的补充第34页/共36页Thanks第35页/共36页感谢您的观赏第36页/共36页