冠脉压力测量血流储备分数FFR.ppt

* * Kom ih?g att ta ut n?len. * * By the definition of the FFRmyo, the measurement has to be done during maximum vasodilation. Maximum vasodilation can be achieved by a couple of different pharmacological drugs; Adenosine ATP – Adenosine Tri-Phosphate Papaverine * * Intermediate stenosis in one or more coronary arteries, even bypass grafts. (Evidence of ischemia?) Serial lesions (Culprit? Cumulative effect?) Diffuse disease (Focal treatable region?) Ostial or distal left main and ostial right lesions (Significant?) Sidebranch lesions (Significant?) Multivessel Disease (Culprit?) In-stent restenosis(Conservative management or revascularization?) Prior MI(A surrogate for non-invasive testing?) FFR is not applicable/validated in: Severe left ventricular hypertrophy, STEMI/transmural myocardial infarction 5 days. * * Despite a severe stenosis, the myocardium may be receiving an adequate supply of blood from collaterals. In this case the collaterals are well developed. FFR takes into account the contribution of collateral blood supply to the perfusion area. FFR always provides the information necessary for deciding whether or not to intervene. * * FFR is measured during a diagnostic angiogram or angioplasty when the angio images are inconclusive and the cardiologist is uncertain how to treat the patient. FFR is used to assess for example single intermediate lesions, tandem lesions, diffuse disease, multivessel disease (mvd) and left main. A critical question the cardiologist must answer is whether or not the lesion being assessed is causing inducible ischemia Studies such as Iskander et al. have shown that a person is significantly more likely to die or have a myocardial infarction (M.I.) if they have a lesion causing inducible ischemia compared to one that does not. * International practice guidelines for percutaneous coronary intervention recommend Fractional Flow Reserve as a valuable tool to provide evidence of ischemia before a stenosis is con