FFR的基本概念和技术.ppt

FFR Definition 精品 精选文档 FFR Definition 精品 精选文档 FRACTIONAL FLOW RESERVE: The index FFR (Fractional Flow Reserve) is based upon the two following principles: It is not resting flow, but maximum achievable flow which determines the functional capacity (exercise tolerance) of a patient At maximum vasodilation (corresponding with maximum hyperemia or with maximum exercise), blood flow to the myocardium is proportional to myocardial perfusion pressure (~hyperemic distal coronary pressure) 精品 精选文档 Normal Value of Myocardial Fractional Flow Reserve Normal FFR = 1 Pa Pd FFR = Pa Pd 精品 精选文档 0.014〞 3 cm Pressure Monitoring Guide Wires 精品 精选文档 Coronary Hyperemic Stimuli 精品 精选文档 PRACTICE OF CORONARY PRESSUREMEASUREMENT AND FFR 〔1〕 1. Verification of equal signals when sensor at tip of the guiding catheter. Equalization if necessary 2. Advance wire, sensor crosses stenosis 3. Induce maximum hyperemia and measure FFR 4. Because sensor is 3 cm from tip, easily pull-back and push-up for exact spatial information. If desirable, perform pull-back recording 精品 精选文档 PRACTICE OF CORONARY PRESSUREMEASUREMENT AND FFR 〔2〕 5. PCI if indicated, with possibility for Pw measurement for collateral flow assessment 6. Followed by FFR measurement to check result. If desired, perform hyperemic pull-back recording 7. verify absence of drift at the end of procedure, or between measurement in several vessels 精品 精选文档 LAD resting adenosine i.v. 精品 精选文档 pull-back across LAD plaque hyperemic pull-back recording 精品 精选文档 200 100 0 200 100 0 Aortic Pressure = 122 mm Hg Aortic Pressure = 89 mm Hg Coronary Pressure = 52 mm Hg Coronary Pressure = 40 mm Hg ΔP = 70 mmHG FFR = 52/122 = 0.43 FFR = 40/89 = 0.45 Influence of Systemic Pressure on Transstenotic Gradient ΔP = 49 mmHG 精品 精选文档 1 Exercise Test Thallium Scan Dobut. echo 0.3 0.4 0.5 0.6 0.7 0.8 0.9 True Positive Stress Tests Negative Stress Tests FFR and Non-Invasive Stress