FFR基本概念和实际操作_陈韵岱.ppt

FFR基本概念和实际操作 中国人民解放军总医院心内科 陈韵岱 教授 FFR-评价冠脉狭窄的功能性（生理学）指标 冠脉造影及血管内超声均被认为是诊断冠心病的“金指标”，但它们只能对狭窄程度进行影像学的评价，而狭窄对远端血流产生了多大的影响（功能评价）却不得而知。 1993年Nico Pijls提出了通过压力测定推算冠脉血流的新指标-血流储备分数（Fractional Flow Reserve, FFR)。经过长期的基础与临床研究，FFR已经成为评价冠脉狭窄的功能性改变的生理学公认指标。 FFR的定义 FFR= FFR的定义 冠脉 FFR的定义 FFR的临界值 FFR的界值 FFR VS IVUS FFR-心肌灌注面积及侧枝循环 FFR解释了以下几方面的相互关系： 心外膜下血管狭窄的严重程度 心肌灌注面积的范围 心肌血流量（考虑了侧枝循环） 可诱导心肌缺血的存在 小结 FFR 正常值=1，0.75-0.80灰色地带，FFR0.75,特异度100%； FFR不受血流动力学的影响（心率、血压等）； FFR解释了心外膜下血管的狭窄病变对远端心肌灌注血流的影响； FFR考虑了侧枝循环； FFR非常容易测量和有非常好的重复性； 通过PULL BACK方式，能对血管进行整体评估。 小结 FFR可以给介入医生的在制定患者治疗策略时提供更多信息和依据，因为： 血管造影术本身的局限性 形态学和功能学的差异 无创评估指标的局限性 不加选择的使用DES的潜在不利因素 * * * * * * * * * The slides in this presentation are intended to illustrate the following: Defining the significance of a given CSA (lumen cross sectional area) by IVUS is dependant on the normal size of the artery which varies considerably from one artery to another and from one person to another. FFR is a relative index that takes into account the size of the person and the size of the vessel. Physiologic stenosis severity cannot be judged without taking into account the perfusion area.IVUS is only a picture of the vessel and does not tell us about the needs of the perfusion area supplied by the vessel. FFR is a relative index that takes into account size of perfusion area. - Collaterals modify physiologic stenosis severity. IVUS does not tell us how much collaterals contribute to supplying the myocardium. FFR is a relative index that takes into account collateral function. - An increase or decrease in the severity of one lesion will modify the physiologic stenosis severity of other lesions in series. IVUS is only a picture, and the picture of one stenosis will not change if another stenosis in the same vessel is stented. FFR for an entire vessel may very well change before and after stenting of one stenosis in series because in a series, one stenosis affects another. - In the case of a long, diffuse lesion, IVUS may