FFR的基本概念和技术.ppt

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1、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导管室的特殊运动试验冠状动脉造影的补充冠状动脉血流量的生理调节TheCoronaryCirculation-AnatomyAoPaPvCollateralsMyocardiumepicardialarterialvessels-myocardialmicrocirculation-venouscomponentPhysicsLawKlocke,FJ,MeasurementofCoronaryFlowReserve:Definingpathophysiologyversusmakingdecisi

2、onsaboutpatientcare;Circulation:1987;76:pp1183-1189TheCoronaryCirculation-PhysiologicRegulation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’maxRstenosisRmyocardialFFRCFRCFRandrCFR:WhatDoTheyInvestigate?一个假

3、设病例A：狭窄60％DM微血管病变B：狭窄80％没有微血管病变CFRamaybe=CFRb＝2or1.7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/PaWhyFlow(Q)=PressureCoronaryStenosisRheologyPressure-FlowRelationshipPressuredropacrossstenosisincreaseswithflowinanon-linearfashionEntranceeffectsSeparation

4、lossesFrictionlossFFRDefinitionFFRDefinitionFFRDefinitionFRACTIONALFLOWRESERVE:TheindexFFR(FractionalFlowReserve)isbaseduponthetwofollowingprinciples:Itisnotrestingflow,butmaximumachievableflowwhichdeterminesthefunctionalcapacity(exercisetolerance)ofapatientAtmaximumvasodilation

5、(correspondingwithmaximumhyperemiaorwithmaximumexercise),bloodflowtothemyocardiumisproportionaltomyocardialperfusionpressure(~hyperemicdistalcoronarypressure)NormalValueofMyocardialFractionalFlowReserveNormalFFR=1PaPdFFR=PaPd0.014”3cmPressureMonitoringGuideWiresCoronaryHyperemic

6、StimuliPRACTICEOFCORONARYPRESSUREMEASUREMENTANDFFR（1）1.Verificationofequalsignalswhensensorattipoftheguidingcatheter.Equalizationifnecessary2.Advancewire,sensorcrossesstenosis3.InducemaximumhyperemiaandmeasureFFR4.Becausesensoris3cmfromtip,easilypull-backandpush-upforexactspati

7、alinformation.Ifdesirable,performpull-backrecordingPRACTICEOFCORONARYPRESSUREMEASUREMENTANDFFR（2）5.PCIifindicated,withpossibilityforPwmeasurementforcollateralflowassessment6.FollowedbyFFRmeasurementtocheckresult.Ifdesired,performhyperemicpull-backrecording7.verifyabsenceofdrift

8、attheendofprocedure,orbetweenmeasurementinsever