郭丽君-FFR-天津会郭丽君.ppt

FFR评估冠脉病变的功能严重程度 郭丽君 北京大学第三医院心内科 病变≠ 缺血 无创功能评价的问题 Most patients undergoing catheterization do not have noninvasive evaluation for ischemia Regional assessment of ischemia often does not correlate with angiographic severity Prediction of ischemia based on angiographic severity is inconsistent by Inter- and intraobserver variability Challenge of interpreting multiple sequential lesions of intermediate angiographic significance There is a need in the catheterization laboratory for physiologic and anatomic tools to complement angiography FFR测量的理论基础 正常状态下，血流经心外膜血管传导时，压力恒定； 在阻力血管最大扩张状态下，心肌血流量与灌注压成正比 狭窄使冠脉灌注压力（即狭窄以远的压力）降低 FFR的定义和公式假设 FFR被定义为狭窄存在和正常时 心肌最大血流量（ QS ，QN ）的 比值 （Pa－Pv） （Pd－Pv） QN ＝ QS ＝ R R FFR=（pd-pv）/（pa-pv） = pd/pa 压力资料的计算 心肌流量储备分数 FFRmyo =（pd-pv）/（pa-pv）= pd/pa 冠脉流量储备分数 FFRcor =（pd-pw）/（pa-pw） 侧枝流量储备分数 Qc/Qn=（FFRmyo-FFRcor） （pa-pv）/（pw-pv）=1+Rc/R=常数 FFR的特点 临床应用- DEFER研究 FAME研究 Which Lesions Need FFR? FFR和CAG评价的病变血管 FFR for Assessing LM Significance CAG和FFR评价LM临界病变 CAG和FFR评价LM临界病变 FFR评价“Jailed”分支 FFR of “jailed” Circumflex FFR of “jailed” Circumflex FFR IN ACUTE CORONARY SYNDROMES Acute chest pain without ΔECG or enzyme elevation: FFR applicable as usual Acute chest pain with ΔECG or elevenzymes / non-STEMI A. single vessel disease or culprit lesion clear from ECG no FFR indicated, treat culprit. Use FFR, if indicated, in case of other lesions B. If culprit not clear, use FFR as usual. Note: if time interval 48 h use FFR as usual. STEMI/transmural myocardial infarction: FFR not to be applied in first 5 day FFR vs SVG patency 为什么我们需要FFR? FFR is a simple, lesion-specific physiologic index that correlates with ischemia by noninvasive testing an clinical outcome Essential tool in the cath