1、冠脉结构检测冠脉结构检测冠脉生理检测冠脉生理检测无创性检测无创性检测磁共振血管成像磁共振血管成像(MRA)磁共振心脏成像磁共振心脏成像(MRI)冠脉血流储备冠脉血流储备(超声多普勒超声多普勒CFR)CTAPET缺血检查缺血检查(运动运动/药物激发试验药物激发试验)心电图心电图 超声心动图超声心动图 放射性核素心肌显像放射性核素心肌显像心导管相关的检测心导管相关的检测冠脉造影冠脉造影冠脉血流流速冠脉血流流速IVUS/VH-IVUS冠脉内压力冠脉内压力Infra-redOCT介入性心脏病学介入性心脏病学冠状动脉疾病的冠状动脉疾病的“专家专家”n充分理解冠脉的充分理解冠脉的结构结构n充分理解冠脉的充
2、分理解冠脉的生理机能生理机能二者缺一不可二者缺一不可!n存在狭窄病变时，血管的最大血流量除以假设不存在狭窄病变时所能获得的最大血流量。nFFR是一个冠脉狭窄的功能性评价指标。Pijls and De Bruyne,Coronary Pressure Kluwer Academic Publishers,200010050Pa=Guiding CatheterPd=Pressure WirePaPd1=PP=FFRadmyo=1PP=FFRadmyoNormal FFR=1.0Pa PdPd=Pa100100存在狭窄病变存在狭窄病变FFRPa PdPd Pa100701PP=FFRadmyon
3、心外膜下血管狭窄的严重程度n 心肌灌注面积的范围n 心肌血流量n 可诱导的心肌缺血10060FFR=0.60Large perfusion areaFFR=0.8510085Small perfusion areaNormal myocardiumScar tissueNormalmyocardiumFFR=0.80FFR=0.601006010080FFR=0.70PdPv010070Pa100Poorly developed collateralsFFR=0.85PdPv010085100PaWell developed collaterals54-yo man,PTCA prox LAD
4、 8 years ago,stable angina,occluded distal LCx.48-yo man,aborted sudden death.No other stenosis at angio.What do I do now?Pijls N,et al.NEJM.1996;334:1703-08.Pijls N,et al;NEJM,1996;334:1703-1708FFR 0.75 心肌缺血(特异度 100%)FFR 0.75 心肌缺血的可能性非常小(敏感度 88%)1.00.8000.75DEFER GroupPERFORM GroupREFERENCE GroupBe
5、ch GJ,et al.Circulation 2001:103;2873-5.Randomizedn在确定冠脉狭窄病变是否是造成远端心肌缺血的原因，测量FFR具有重要的预示作用。nFFR 0.75FFR=0.89 0.75FFR=0.90 0.75RCAFFR=0.41 FFR=0.67After balloon inflation 3.0 balloon 12 atm(mid-RCA)After stent 3.5 mm(mid-RCA)FFR=0.80Not optimal post stent resultStent 3.5 mm(mid-RCA)+Stent 3.5 mm(prox-
6、RCA)FFR=0.94Optimal post stent resultNo inducible ischemiaInducibleischemiaIschemia at rest ornecrosis0.750.800.201.0Gray Zone 评估病变After stent implantationFFR 0.94 =Optimum stent resultAfter balloon angioplastyFFR 0.90 =Excellent result1.00.75interventionalsuccessoptimalsuboptimalno success0.94指导治疗Pijls N,et al.Circulation,2002;105:2950-540.96 4,9%0.91-0.95 6,2%0.86-0.90 16,2%0.81-0.85 22,2%0.75-0.80 29,5%FFR after stent*deploymentTVR(6 ms follow-up)*Bare metal stents
