FFR的基本概念和技术.pptVIP

FFR的基本概念和技术 阜外医院 钱杰 冠状动脉血流动力学测定 冠状动脉血流量的生理调节 Physics Law 生理调节的指标 CFR＝Qsmax /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3－5倍吗？它能反应病变情况吗？ 不能， 能，但没有特异性 rCFR(RFR)=Qsmax /Qn’max 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 =CFRb＝2 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 FFR＝Qsmax /Qnmax =Pd/Pa Why Flow (Q) = Pressure FFR Definition FFR Definition FFR Definition PRACTICE OF CORONARY PRESSUREMEASUREMENT AND FFR （1） 1. Verification of equal signals when sensor at tip of the guiding catheter. Equalization if necessary 2. Advance wire, sensor crosses stenosis 3. Induce maximum hyperemia and measure FFR 4. Because sensor is 3 cm from tip, easily pull-back and push-up for exact spatial information. If desirable, perform pull-back recording PRACTICE OF CORONARY PRESSUREMEASUREMENT AND FFR （2） 5. PCI if indicated, with possibility for Pw measurement for collateral flow assessment 6. Followed by FFR measurement to check result. If desired, perform hyperemic pull-back recording 7. verify absence of drift at the end of procedure, or between measurement in several vessels 冠状动脉血流动力学测定 Thanks 200 100 0 200 100 0 Aortic Pressure = 122 mm Hg Aortic Pressure = 89 mm Hg Coronary Pressure = 52 mm Hg Coronary Pressure = 40 mm Hg ΔP = 70 mmHG FFR = 52/122 = 0.43 FFR = 40/89 = 0.45 Influence of Systemic Pressure on Transstenotic Gradient ΔP = 49 mmHG 1 Exercise Test Thallium Scan Dobut. echo 0.3 0.4 0.5 0.6 0.7 0.8 0.9 True Positive Stress Tests Negative Stress Tests FFR and Non-Invasive Stress Testing in Lesions of Intermediate Severity Pijls NHJ, de Bruyne B, Peels K et al. New Engl J Med 1996 Ischemic Threshold Values of FFR A A A u u u t t t h h h o o o r r r s s s R R R e e e f f f P P P a a a t t t i i i e e e n n n t t t s s s # # # T T T e e e s s s t t t T T T h h h r r r e e e s s s h h h o o o l l l d d d De Br