刘存,孙浩宁,聂文畅,卢亚辉,郭萌,孙宇彤,史轶群,刘健

• 1:北京大学人民医院心内科

摘要(Abstract)：

心肌所获得的血流量减少会影响冠心病患者的预后。血流储备分数（FFR）通过测定冠状动脉血管内压力的变化，能对冠状动脉内血流速度或流量及心肌获得的血流量进行有效的分析，并用于协助判断启动介入治疗的时机。基于冠状动脉CT血管造影的FFR(FFR-CT)可根据非侵入性的冠状动脉CT成像计算得出FFR的模拟数值，进而较好地反映冠状动脉的血流动力学情况。本文系统地阐述了FFR-CT的基本原理及应用于临床实践的循证医学证据，并对FFR-CT在经皮冠状动脉介入治疗领域的应用前景进行了展望。

关键词(KeyWords)： 基于冠状动脉CT的血流储备分数;经皮冠状动脉介入治疗;冠状动脉功能学评价;冠心病

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 刘存,孙浩宁,聂文畅,卢亚辉,郭萌,孙宇彤,史轶群,刘健

参考文献(References)：

• [1]刘健，熊玮珏，王伟民.《2015年美国心脏病学会/美国心脏协会/美国心血管造影与介入学会ST段抬高心肌梗死患者处理指南更新》解读[J].中国介入心脏病学杂志，2016, 24(11):607-611.
• [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，中华心血管病杂志委员会.中国经皮冠状动脉介入治疗指南（2016）[J].中华心血管病志，2016,44(5):382-400.
• [3] Asher A, Ghelani R, Thornton G, et al. UK perspective on the changing landscape of non-invasive cardiac testing[J].Open Heart, 2019, 6(2):e001186.
• [4] Pijls NHJ,Fearon WF,Tonino PA, et al. Fractional flow reserve versus angiography for guiding percutaneous coronary interventionin patients with multivessel coronary artery disease:2-year follow up of the FAME(fractional flow reserve versus angiography for multivessel valuation)study[J]. J Am Coll Cardiol,2010,56(3):177-184.
• [5] De Bruyne B,Pijls NHJ,Kalesan B,et al. Fractional flow reserve guided PCI versus medical therapy in stable coronary disease[J]. N Engl J Med,2012,367(11):991-1001.
• [6]余作忠，杨人强.基于影像学的血流储备分数衍生指标研究进展[J].中国介入心脏病学杂志，2021, 29(3):164-168.
• [7] d’Othée BJ, Siebert U, Cury R, et al. A systematic review on diagnostic accuracy of CT-based detection of significant coronary artery disease[J]. Eur J Radiol, 2008, 65(3):449-461.
• [8] Sekhri N, Feder GS, Junghans C, et al. How ef fective are rapid access chest pain clinics? Prognosis of incident angina and non-cardiac chest pain in 8762 consecutive patients[J]. Heart,2007, 93(4):458-463.
• [9] Newby DE, Adamson PD, Berry C, et al. Coronary CT angiography and 5-year risk of myocardial infarction[J]. N Engl J Med, 2018, 379(10):924-933.
• [10] Pijls NH,van Son JA,Kirkeeide RL,et al.Experimental basis of determining maximum coronary, myocardial, and collateral blood flow by pressure measurements for assessing functional stenosis severity before and after percutaneous transluminal coronary angioplasty[J]. Circulation, 1993, 87(4):1354-1367.
• [11] Min JK, Taylor CA, Achenbach S, et al. Noninvasive fractional flow reserve derived from coronary ct angiography:clinical data and scientific principles[J]. JACC Cardiovasc Imaging, 2015, 8(10):1209-1222.
• [12] Koo BK, Erglis A, Doh JH, et al. Diagnosis of ischemiacausing coronary stenoses by noninvasive fractional fl ow reserve computed from coronary computed tomographic angiograms.Results from the prospective multicenter DISCOVER-FLOW(diagnosis of ischemia-causing stenoses obtained via noninvasive fractional fl ow reserve)study[J]. J Am Coll Cardiol, 2011,58(19):1989-1997.
• [13] Min JK, Leipsic J, Pencina MJ, et al. Diagnostic accuracy of fractional fl ow reserve from anatomic CT angiography[J].JAMA, 2012, 308(12):1237-1245.
• [14] N?Rgaard 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 fl ow using ct angiography:next steps)[J]. J Am Coll Cardiol, 2014, 63(12):1145-1155.
• [15] Douglas PS, De Bruyne B, Pontone G, et al. 1-Year outcomes of FFRCT-guided care in patients with suspected coronary disease[J]. J Am Coll Cardiol, 2016,68(5):435-445.
• [16] Patel MR, N?rgaard BL, Fairbairn TA, et al. 1-Year impact on medical practice and clinical outcomes of FFRCT:the ADVANCE registry[J]. JACC Cardiovasc Imaging, 2020,13(1 Pt 1):97-105.
• [17]邓欣，沈雳，王瑞，等.基于冠状动脉CT的血流储备分数在心肌缺血中的诊断应用价值：一项单中心前瞻性研究[J].中国介入心脏病学杂志，2021, 29(3):138-142.
• [18] Curzen N, Nicholas Z, Stuart B, et al. Fractional fl ow reserve derived from computed tomography coronary angiography in the assessment and management of stable chest pain:the FORECAST randomized trial[J]. Eur Heart J, 2021, 42(37):3844-3852.
• [19]成水华，倪炯，刘君，等.基于人工智能技术的FFR CT评估左冠状动脉前降支纵深型心肌桥血流动力学变化[J].中华医学杂志，2021, 101(7):464-469.
• [20] Kim KH, Doh JH, Koo BK, et al. A novel noninvasive technology for treatment planning using virtual coronary stenting and computed tomography-derived computed fractional flow reserve[J]. JACC Cardiovasc Interv, 2014, 7(1):72-78.
• [21] Fournier S, Ciccarelli G, Toth GG, et al. Association of improvement in fractional fl ow reserve with outcomes, including symptomatic relief, after percutaneous coronary intervention[J]. JAMA Cardiol, 2019, 4(4):370-374.
• [22] Modi BN, Sankaran S, Kim HJ, et al. Predicting the physiological ef fect of revascularization in serially diseased coronary arteries:clinical validation of a novel CT coronary angiography–based technique[J]. Circ Cardiovasc Interv,2019, 12(2):e007577.
• [23] N?rgaard BL, Hjort J, Gaur S, et al. Clinical use of coronary CTA-derived FFR for decision-making in stable CAD[J].JACC Cardiovasc Imaging, 2017,10(5):541-550.
• [24] Gaur S, Taylor CA, Jensen JM, et al. FFR derived from coronary CT angiography in nonculprit lesions of patients with recent STEMI[J]. JACC Cardiovasc Imaging, 2017, 10(4):424-433.
• [25] Lee JM, Choi G, Koo BK, et al. Identifi cation of high-risk plaques destined to cause acute coronary syndrome using coronary computed tomographic angiography and computational fluid dynamics[J]. JACC Cardiovasc Imaging, 2019, 12(6):1032-1043.
• [26] Rajani R, Webb J, Marciniak A, et al. Comparative e ffi cacy testing—fractional fl ow reserve by coronary computed tomography for the evaluation of patients with stable chest pain[J]. Int J Cardiol, 2015, 183:173-177.