余作忠,杨人强

• 1:南昌大学第二附属医院心内科

摘要(Abstract)：

目前血流储备分数(FFR)已成为评估冠状动脉狭窄生理学意义的金标准,但局限于FFR测定耗时长、操作不便、药物应用潜在的不良反应等因素,其临床实际应用并不普遍。因此,基于FFR的系列衍生技术得到了快速发展,其中基于影像学衍生的FFR技术的诊断性能得到了许多研究的证实。本文将对这一领域的基于冠状动脉CT的FFR(CT-FFR)、定量血流分数(QFR)、血管造影FFR(FFRangio)、基于冠状动脉造影的FFR(caFFR)、基于光学相干断层成像的FFR(OFR)、基于血管内超声的FFR(UFR)的工作原理、诊断效能、临床应用等方面进行综述。

关键词(KeyWords)： 冠状动脉疾病;血流储备分数;功能学评价;影像学

Abstract:

Keywords:

基金项目(Foundation): 国家自然科学基金（81960081）

作者(Author): 余作忠,杨人强

参考文献(References)：

• [1] Neumann FJ, Sousa-Uva M, Ahlsson A, et al. 2018 ESC/EACTS guidelines on myocardial revascularization. Eur Heart J, 2019,40(2):87-165.
• [2]中华医学会心血管病学分会介入心脏病学组，中国医师协会心血管内科医师分会血栓防治专业委员会，中华心血管病杂志编辑委员会.中国经皮冠状动脉介入治疗指南（2016）.中华心血管病杂志，2016,44(5):382-400.
• [3] Tonino PA, Fearon WF, De Bruyne B, et al. Angiographic versus functional severity of coronary artery stenoses in the FAME study fractional flow reserve versus angiography in multivessel evaluation.J Am Coll Cardiol, 2010,55(25):2816-2821.
• [4] Zimmermann FM, Ferrara A, Johnson NP, et al. Deferral vs. performance of percutaneous coronary intervention of functionally non-signifi cant coronary stenosis:15-year follow-up of the DEFER trial. Eur Heart J, 2015,36(45):3182-3188.
• [5] Tonino PA, De Bruyne B, Pijls NH, et al. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention.N Engl J Med, 2009,360(3):213-224.
• [6] Xaplanteris P, Fournier S, Pijls N, et al. Five-year outcomes with PCI guided by fractional flow reserve. N Engl J Med, 2018,379(3):250-259.
• [7] Sen S, Escaned J, Malik IS, et al. Development and validation of a new adenosine-independent index of stenosis severity from coronary wave-intensity analysis:results of the ADVISE(Adenosine Vasodilator Independent Stenosis Evaluation)study. J Am Coll Cardiol, 2012,59(15):1392-1402.
• [8] Johnson NP, Li W, Chen X, et al. Diastolic pressure ratio:new approach and validation vs. the instantaneous wave-free ratio. Eur Heart J, 2019,40(31):2585-2594.
• [9] Lee JM, Choi KH, Park J, et al. Physiological and clinical assessment of resting physiological Indexes. Circulation, 2019,139(7):889-900.
• [10] Shaw LJ, Hausleiter J, Achenbach S, et al. Coronary computed tomographic angiography as a gatekeeper to invasive diagnostic and surgical procedures:results from the multicenter CONFIRM(coronary CT angiography evaluation for clinical outcomes:an international multicenter)registry. J Am Coll Cardiol, 2012,60(20):2103-2114.
• [11] Toth G, Hamilos M, Pyxaras S, et al. Evolving concepts of angiogram:fractional flow reserve discordances in 4000 coronary stenoses. Eur Heart J, 2014,35(40):2831-2838.
• [12] Meijboom WB, Van Mieghem CA, Van Pelt N, et al. Comprehensive assessment of coronary artery stenoses:computed tomography coronary angiography versus conventional coronary angiography and correlation with fractional flow reserve in patients with stable angina. J Am Coll Cardiol, 2008,52(8):636-643.
• [13] Taylor CA, Fonte TA, Min JK. Computational fluid dynamics applied to cardiac computed tomography f or noninvasive quantifi cation of fractional flow reserve:scientifi c basis. J Am Coll Cardiol, 2013,61(22):2233-2241.
• [14] Koo BK, Erglis A, Doh JH, et al. Diagnosis of ischemia-causing coronary stenoses by noninvasive fractional flow reserve computed from coronary computed tomographic angiograms. Results from the prospective multicenter DISCOVER-FLOW(Diagnosis of IschemiaCausing Stenoses Obtained Via Noninvasive Fractional Flow Reserve)study. J Am Coll Cardiol, 2011,58(19):1989-1997.
• [15] Min JK, Leipsic J, Pencina MJ, et al. Diagnostic accuracy of fractional flow reserve from anatomic CT angiography. JAMA,2012,308(12):1237-1245.
• [16] Norgaard BL, Leipsic J, Gaur S, et al. Diagnostic performance of noninvasive fractional flow reserve derived from coronary computed tomography angiography in suspected coronary artery disease:the NXT trial(Analysis of Coronary Blood Flow Using CT Angiography:Next Steps). J Am Coll Cardiol, 2014,63(12):1145-1155.
• [17] Driessen RS, Danad I, Stuijfzand WJ, et al. Comparison of coronary computed tomography angiography, fractional flow reserve, and perfusion imaging for ischemia diagnosis. J Am Coll Cardiol, 2019,73(2):161-173.
• [18] Tang CX, Liu CY, Lu MJ, et al. CT FFR for ischemia-specific CAD with a new computational fluid dynamics algorithm:a Chinese multicenter study. JACC Cardiovasc Imaging, 2020,13(4):980-990.
• [19] Douglas PS, Pontone G, Hlatky MA, et al. Clinical outcomes of fractional flow reserve by computed tomographic angiographyguided diagnostic strategies vs. usual care in patients with suspected coronary artery disease:the prospective longitudinal trial of FFR(CT):outcome and resource impacts study. Eur Heart J, 2015,36(47):3359-3367.
• [20] Douglas PS, De Bruyne B, Pontone G, et al. 1-Year outcomes of FFRCT-guided care in patients with suspected coronary disease:the PLATFORM study. J Am Coll Cardiol, 2016,68(5):435-445.
• [21] Fairbairn TA, Nieman K, Akasaka T, et al. Real-world clinical utility and impact on clinical decision-making of coronary computed tomography angiography-derived fractional flow reserve:lessons from the ADVANCE Registry. Eur Heart J, 2018,39(41):3701-3711.
• [22] Patel MR, Norgaard BL, Fairbairn TA, et al. 1-Year impact on medical practice and clinical outcomes of FFRCT:the ADVANCE registry. JACC Cardiovasc Imaging, 2020,13(1 Pt 1):97-105.
• [23] Xu B, Tu S, Qiao S, et al. Diagnostic accuracy of angiographybased quantitative flow ratio measurements for online assessment of coronary stenosis. J Am Coll Cardiol, 2017,70(25):3077-3087.
• [24] Tu S, Barbato E, Koszegi Z, et al. Fractional flow reserve calculation from 3-dimensional quantitative coronary angiography and TIMI frame count:a fast computer model to quantify the functional significance of moderately obstructed coronary arteries.JACC Cardiovasc Interv, 2014,7(7):768-777.
• [25] Tu S, Westra J, Yang J, et al. Diagnostic accuracy of fast computational approaches to derive fractional flow reserve from diagnostic coronary angiography:the international multicenter FAVOR pilot study. JACC Cardiovasc Interv, 2016,9(19):2024-2035.
• [26] Westra J, Andersen BK, Campo G, et al. Diagnostic performance of in-procedure angiography-derived quantitative flow reserve compared to pressure-derived fractional flow reserve:the FAVORⅡEurope-Japan study. J Am Heart Assoc, 2018,7(14):e009603.
• [27] Kornowski R, Lavi I, Pellicano M, et al. Fractional flow reserve derived from routine coronary angiograms. J Am Coll Cardiol,2016,68(20):2235-2237.
• [28] Pellicano M, Lavi I, De Bruyne B, et al. Validation study of imagebased fractional flow reserve during coronary angiography. Circ Cardiovasc Interv, 2017,10(9):e005259.
• [29] Fearon WF, Achenbach S, Engstrom T, et al. Accuracy of fractional flow reserve derived from coronary angiography. Circulation, 2019,139(4):477-484.
• [30] Li J, Gong Y, Wang W, et al. Accuracy of computational pressurefluid dynamics applied to coronary angiography to derive fractional flow reserve:FLASH FFR. Cardiovascular Research, 2020,116(7):1349-1356.
• [31] Yu W, Huang J, Jia D, et al. Diagnostic accuracy of intracoronary optical coherence tomography-derived fractional flow reserve for assessment of coronary stenosis severity. EuroIntervention, 2019,15(2):189-197.
• [32] Tian F, Yu W, Huang J, et al. First presentation of integration of intravascular optical coherence tomography and computational fractional flow reserve. Int J Cardiovasc Imaging, 2019,35(4):601-602.
• [33] Huang J, Emori H, Ding D, et al. Diagnostic performance of intracoronary optical coherence tomography-based versus angiography-based fractional flow reserve for the evaluation of coronary lesions. EuroIntervention, 2020,16(7):568-576.
• [34] Gutierrez-Chico JL, Chen Y, Yu W, et al. Diagnostic accuracy and reproducibility of optical flow ratio for functional evaluation of coronary stenosis in a prospective series. Cardiol J, 2020,27(4):350-361.
• [35] Emori H, Kubo T, Shiono Y, et al. Comparison of optical flow ratio and fractional flow ratio in stent-treated arteries immediately after percutaneous coronary intervention. Circ J, 2020,84(12):2253-2258.
• [36] Darmoch F, Alraies MC, Al-Khadra Y, et al. Intravascular ultrasound imaging-guided versus coronary angiography-guided percutaneous coronary intervention:A systematic review and meta-analysis. J Am Heart Assoc, 2020,9(5):e13678.
• [37] Jang JS, Shin HC, Bae JS, et al. Diagnostic performance of intravascular ultrasound-derived minimal lumen area to predict functionally significant non-left main coronary artery disease:a meta-analysis. Korean Circ J, 2016,46(5):622-631.
• [38] Seike F, Uetani T, Nishimura K, et al. Intravascular ultrasoundderived virtual f ractional flow reserve for the assessment of myocardial ischemia. Circ J, 2018,82(3):815-823.
• [39] Bezerra CG, Hideo-Kajita A, Bulant CA, et al. Coronary fractional flow reserve derived from intravascular ultrasound imaging:Validation of a new computational method of fusion between anatomy and physiology. Catheter Cardiovasc Interv, 2019,93(2):266-274.