瞬时无波比的理论及应用
孙宇彤,刘健
摘要(Abstract):
<正>当冠心病患者存在一支或多支血管的影响血流动力学的狭窄时,需要对其进行血运重建。2018年欧洲心脏病学会(European SocietyofCardiology,ESC)及欧洲心胸外科协会(European Association for Cardio-Thoracic Surgery,EACTS)关于心肌血运重建的指南~([1])认为,没有缺血的证据时,建议采用冠状动脉生理学指标血流储备分数(fractional flow reserve,FFR)或瞬时无波比(instantaneous wave-free ratio,iFR)来评估存在中度狭窄的冠状动脉血流动力学情况(Ⅰ类推荐)。
关键词(KeyWords): 经皮冠状动脉介入治疗;血运重建;血流储备分数;瞬时无波比
基金项目(Foundation): 国家自然科学基金重点项目(11832003);国家自然科学基金面上项目(81970294);; 北京市科技计划项目(Z171100001017099);; 急性心肌梗死早期预警和干预北京市重点实验室
作者(Author): 孙宇彤,刘健
参考文献(References):
- [1]Neumann FJ,Sousa-Uva M,Ahlsson A,et al.2018 ESC/EACTS Guidelines on myocardial revascularization.Eurointervention,2019,14(14):1435-1534.
- [2]Bech GJ,De Bruyne B,Pijls NH,et al.Fractional flow reserve to determine the appropriateness of angioplasty in moderate coronary stenosis:a randomized trial.Circulation,2001,103(24):2928-2934.
- [3]Tonino PA,De Bruyne B,Pills NH,et al.Fractional flow reserve versus angiography for guiding percutaneous coronary intervention.NEngl JMed,2009,360(3):213-224.
- [4]De Bruyne B,Pijls NH,Kalesan B,et al.Fractional f:low reserve-guided PCI versus medical therapy in stable coronary disease.N Engl J Med,2012,367(11):991-1001.
- [5]颜红兵,霍勇.冠状动脉影像学和生理学的现状与未来.中国介入心脏病学杂志,2019,27(5):241-242.
- [6]Sen S,Escaned I,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.
- [7]Petraco R,Escaned J,Sen S,et al.Classification performance of instantaneous wave-free ratio(iFR)and fractional flow reserve in a clinical population of intermediate coronary stenoses:results of the ADVISE registry.EuroIntervention,2013,9(1):91-101.
- [8]Sen S,Asrress KN,Nijjer S,et al.Diagnostic classification of the instantaneous wave-free ratio is equivalent to fractional flow reserve and is not improved with adenosine administration.Results of CLARIFY(Classification Accuracy of Pressure-Only Ratios Against Indices Using Flow Study).J Am Coll Cardiol,2013,61(13):1409-1420.
- [9]Davies JE,Sen S,Dehbi HM,et al.Use of the Instantaneous Wave-free Ratio or Fractional Flow Reserve in PCI.N Engl J Med,2017,376(19):1824-1834.
- [10]Gotberg M,Christiansen EH,Gudmundsdottir IJ,et al.Instantaneous Wave-free Ratio versus Fractional Flow Reserve to Guide PCI.N Engl J Med,2017,376(19):1813-1823.
- [11]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.Circulation,1993,87(4):1354-1367.
- [12]Davies JE,Whinnett ZI,Francis DP,et al.Evidence of a dominant backward-propagating"suction"wave responsible for diastolic coronary filling in humans,attenuated in left ventricular hypertrophy.Circulation,2006,113(14):1768-1778.
- [13]Pijls NH,van Schaardenburgh P,Manoharan G,et al.Percutaneous coronary intervention of functionally nonsignificant stenosis:5-year follow-up of the DEFER Study.J Am Coll Cardiol,2007,49(21):2105-2111.
- [14] Zimmermann FM,Ferrara A,Johnson NP,et al.Deferral vs.performance of percutaneous coronary intervention of functionally non-significant coronary stenosis:15-year follow-up of the DEFER trial.Eur Heart J,2015,36(45):3182-3188.
- [15]何立芸,张瑞涛,张永珍.瞬时无波形比值与血流储备分数的相关性及其影响因素.中国介入心脏病学杂志,2020,28(1):3-9.
- [16]de Bruyne B,Bartunek J,Sys SU,et al.Simultaneous coronary pressure and flow velocity measurements in humans.Feasibility,reproducibility,and hemodynamic dependence of coronary flow velocity reserve,hyperemic flow versus pressure slope index,and fractional flow reserve.Circulation,1996,94(8):1842-1849.
- [17]Escaned J,Ryan N,Mejia-Renteria H,et al.Safety of the deferral of coronary revascularization on the basis of instantaneous wave-free ratio and fractional flow reserve measurements in stable coronary artery disease and acute coronary syndromes.JACC Cardiovase Interv,2018,11(15):1437-1449.
- [18]Van Belle E,Gil R,Klauss V,et al.Impact of routine invasive physiology at time of angiography in patients with multivessel coronary artery disease on reclassification of revascularization strategy:results from the DEFINE REAL study.JACC Cardiovasc Interv,2018,11(4):354-365.
- [19]Kim HL,Koo BK,Nam CW,et al.Clinical and physiological outcomes of fractional flow reserve-guided percutaneous coronary intervention in patients with serial stenoses within one coronary artery.JACC Cardiovasc Interv,2012,5(10):1013-1018.
- [20]Nijjer SS,de Waard GA,Sen S,et al.Coronary pressure and flow relationships in humans:phasic analysis of normal and pathological vessels and the implications for stenosis assessment:a report from the Iberian-Dutch-English(IDEAL)collaborators.Eur Heart J,2016,37(26):2069-2080.
- [21]Nijjer SS,Sen S,Petraco R,et al.Pre-angioplasty instantaneous wave-free ratio pullback provides virtual intervention and predicts hemodynamic outcome for serial lesions and diffuse coronary artery disease.JACC Cardiovasc Interv,2014,7(12):1386-1396.
- [22]Kikuta Y,Cook CM,Sharp ASP,et al.Pre-angioplasty instantaneous wave-free ratio pullback predicts hemodynamic outcome in humans with coronary artery disease:primary results of the international multicenter iFR GRADIENT registry.JACC Cardiovasc Interv,2018,11(8):757-767.
- [23]Moscona JC,Stencel JD,Milligan G,et al.Physiologic assessment of moderate coronary lesions:a step towards complete revascularization in coronary artery bypass grafting.Ann TranslMed,2018,6(15):300.
- [24]Yamanaka F,Shishido K,Ochiai T,et al.Instantaneous wave-free ratio for the assessment of intermediate coronary artery stenosis in patients with severe aortic valve stenosis:comparison with myocardial perfusion scintigraphy.JACC Cardiovasc Interv,2018,11(20):2032-2040.
- [25]Modi BN,Rahman H,Kaier T,et al.Revisiting the optimal fractional flow reserve and instantaneous wave-free ratio thresholds for predicting the physiological significance of coronary artery disease.Circ Cardiovasc Interv,2018,11(12):e007041.
- [26]Kang DY,Ahn JM,Lee CH,et al.Deferred vs.performed revascularization for coronary stenosis with grey-zone fractional flow reserve values:data from the IRIS-FFR registry.Eur Heart J,2018,39(18):1610-1619.
- [27]Escaned J,Collet C,Ryan N,et al.Clinical outcomes of state-of-the-art percutaneous coronary revascularization in patients with de novo three vessel disease:1-year results of the SYNTAX II study.Eur Heart J,2017,38(42):3124-3134.
- [28]丁浩,施有为,肖建强,等.血流储备分数在冠状动脉临界病变治疗决策中的应用价值.中国心血管病研究,2019,17(7):611-614.
- [29] Davies JE,Cook CM.Is now the time to debate traditional fractional flow reserve/instantaneous wave-free ratio cut points?Circulation:Cardiovascular Interventions,2018,11(12):e007562.