阜外FFR原理及临床应用

1、冠脉病变的解剖和功能学评价冠脉病变的解剖和功能学评价fractional flow reserve, ffrfractional flow reserve, ffr需要测量ffr65%20%7.915.715.70 05 5101015152020% %p=0.20p=0.20p 0.03p 0.03p 0.005p 0.75 ffr 0.75 ffr 0.75ffr 50% in at least 2 major coronary arteries and/or in the left main stem”3-vd 14%1-vd 34%2-vd 43%0-vd9%fame

2、 studyfame studyangiographic 3-vd (n=115)造影所示三支血管病变中造影所示三支血管病变中有功能学意义的病变血管的比例有功能学意义的病变血管的比例p. tonino et al jacc 2010melikian n, et al. j am coll cardiol intv 2010;3:30714cumulative event-free survivaltime to follow-up (in years)1.522.533.544.5501unadjusted p=0.001risk-adju

3、sted p=0.0825% reduction in ischemic myocardium (n=68)no significant reduction in ischemia (n=37)courage nuclear substudyshaw lj, et al. circulation 2008;117:1283-1291lin ga et al. jama 2008;300:1765-1773kern mj. cardiol clin 2011; 29 237267ffr = pd / pa during hyperemia= 89 / 108= 0.82ffr of the rc

4、affr of the rcaffr left circumflexffr left circumflexffr = 0.720.72across proximal lesionacross mid diseasepullback in circumflexpullback in circumflexmost of gradient occurs across proximal lesionafter “spot-stenting” proximal circumflexafter “spot-stenting” proximal circumflexffr = 0.97ffr in acut

5、e coronary syndromesffr in acute coronary syndromesnon-culpritculpritfame trial: fame trial: substudy: acs versus stable anginasubstudy: acs versus stable anginaffr,acs, n= 150angio acs, n=178data suggest that like the overall population, a 30% reduction in mace when ffr is used to guide revasculari

6、zation in acswww.cardio-aalst.befame, syntax, courage, .treatment options for mvd pcicabgomtfamesyntaxcourageffr-guided syntax score (fss) versus ffr-guided syntax score (fss) versus conventional syntax score (ss)conventional syntax score (ss)fssss32% of patients moved to a lower-risk group 497 pati

7、ents of the ffr-arm of fame i497 patients of the ffr-arm of fame i syntax scored re-calculated by 3 incdependant reviewers syntax scored re-calculated by 3 incdependant reviewersfunctional ( ffr) syntax score : counting only the lesions with ffr 0.80functional ( ffr) syntax score : counting only the lesions with ffr 0.80 ffr0.80 should beshould be safe and effective safe and effective functional syntax score may reducing the number and functional syntax score may reducing the number and length of stents /vessel and or /patient is translate