[1]陈忠秀 李娅姣 李春梅 李晨.无导丝虚拟血流储备分数技术在稳定性冠心病介入治疗中的指导价值[J].心血管病学进展,2022,(10):865.[doi:10.16806/j.cnki.issn.1004-3934.2022.10.001]
　CHEN Zhongxiu,LI Yajiao,LI Chunmei,et al.The Value of Wireless Virtual Fractional Flow Reserve in Guiding Percutaneous Coronary Intervention in Stable Coronary Artery Disease[J].Advances in Cardiovascular Diseases,2022,(10):865.[doi:10.16806/j.cnki.issn.1004-3934.2022.10.001]
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无导丝虚拟血流储备分数技术在稳定性冠心病介入治疗中的指导价值()
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《心血管病学进展》[ISSN:51-1187/R/CN:1004-3934]

卷:
期数:
2022年10期
页码:
865
栏目:
综述
出版日期:
2022-10-25

文章信息/Info

Title:
The Value of Wireless Virtual Fractional Flow Reserve in Guiding Percutaneous Coronary Intervention in Stable Coronary Artery Disease
作者:
陈忠秀 李娅姣 李春梅 李晨
(四川大学华西医院心内科,四川 成都 610041)
Author(s):
CHEN Zhongxiu; LI Yajiao; LI Chunmei; LI Chen
(Department of Cardiology,West China Hospital of Sichuan University,Chengdu 610041,Sichuan,China)
关键词:
稳定性冠心病; 血流储备分数; 计算流体动力学; 冠状动脉CT血管成像; 冠状动脉造影; 光学相关断层成像; 血管内超声; 人工智能
Keywords:
Stable coronary artery disease; Fractional flow reserve; Computational fluid dynamics; Coronary artery computed tomography angiography; Coronary angiography; Optical coherence tomography; Intravascular ultrasound; Artificial intelligence
DOI:
10.16806/j.cnki.issn.1004-3934.2022.10.001
摘要:
欧洲和中国冠心病介入治疗指南均以最高级别推荐对稳定性冠心病（SCAD）患者采用血流储备分数（FFR）进行冠状动脉病变的功能学评估并指导血运重建。然而，由于FFR存在价格昂贵、血管扩张药引起患者不适等缺点，导致其难以在临床普及。基于影像计算的多种无导丝/无腺苷的FFR技术应运而生，无导丝虚拟FFR技术具有廉价、快捷、方便的优势，有望大幅拓展冠状动脉病变功能学评估的临床应用。现就冠状动脉病变功能学评估的价值及目前面临的挑战，现有无导丝虚拟FFR技术各自的优缺点，无创冠状动脉生理学检查的发展方向进行综述，以期阐明无导丝虚拟FFR在SCAD患者血运重建中的指导价值、存在的局限性及未来研究改进的方向。
Abstract:
Both domestic and foreign guidelines strongly recommended using fractional flow reserve (FFR) to assess the hemodynamic significance of coronary lesion and to guide revascularization in patients with stable coronary artery disease (SCAD). However,the high expense and discomfort related to vasodilator prevented extensive clinical application of wire based FFR. A variety of guidewire/adenosine-free FFR approaches based on coronary imaging and hemodynamic stimulation have emerged. The guidewire-free virtual FFR technology is expected to greatly expand the clinical application of functional assessment of coronary artery lesions. This article reviews the value and current challenges of functional assessment of coronary artery lesions,the advantages and disadvantages of the existing guidewire-free virtual FFR approaches,and the development direction of non-invasive coronary physiology examination,which aiming to clarify the guiding value,existing limitations and future directions for improvement of guidewire-free virtual FFR in the revascularization of patients with SCAD.

参考文献/References:


[1] Ibanez B,James S,Agewall S,et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation:The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC)[J]. Eur Heart J,2018,39(2):119-177.

[2] 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]. J Am Coll Cardiol,2007,49(21):2105-2111.

[3] Tonino PA,de Bruyne B,Pijls NH,et al. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention[J]. N Engl J Med,2009,360(3):213-224.

[4] Fearon WF,Shilane D,Pijls NH,et al. Cost-effectiveness of percutaneous coronary intervention in patients with stable coronary artery disease and abnormal fractional flow reserve[J]. Circulation,2013,128(12):1335-1340.

[5] Fearon WF,Nishi T,de Bruyne B,et al. Clinical outcomes and cost-effectiveness of fractional flow reserve-guided percutaneous coronary intervention in patients with stable coronary artery disease:three-year follow-up of the FAME 2 trial (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation)[J]. Circulation,2018,137(5):480-487.

[6] Johnson NP,Toth GG,Lai D,et al. Prognostic value of fractional flow reserve:linking physiologic severity to clinical outcomes[J]. J Am Coll Cardiol,2014,64(16):1641-1654.

[7] Neumann FJ,Sousa-Uva M,Ahlsson A,et al. 2018 ESC/EACTS Guidelines on myocardial revascularization[J]. Eur Heart J,2019,40(2):87-165.

[8] 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 Ischemia-Causing Stenoses Obtained Via Noninvasive Fractional Flow Reserve) study[J]. J Am Coll Cardiol,2011,58(19):1989-1997.

[9] Min JK,Leipsic J,Pencina MJ,et al. Diagnostic accuracy of fractional flow reserve from anatomic CT angiography[J]. JAMA,2012,308(12):1237-1245.

[10] 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 Flow Using CT Angiography:Next Steps)[J]. J Am Coll Cardiol,2014,63(12):1145-1155.

[11] Cook CM,Petraco R,Shun-Shin MJ,et al. Diagnostic accuracy of computed tomography-derived fractional flow reserve:a systematic review[J]. JAMA Cardiol,2017,2(7):803-810.

[12] Zhuang B,Wang S,Zhao S,et al. Computed tomography angiography-derived fractional flow reserve (CT-FFR) for the detection of myocardial ischemia with invasive fractional flow reserve as reference:systematic review and meta-analysis[J]. Eur Radiol,2020,30(2):712-725.

[13] Luo Y,Mao M,Xiang R,et al. Diagnostic performance of computed tomography-based fraction flow reserve in identifying myocardial ischemia caused by coronary artery stenosis:a meta-analysis[J]. Hellenic J Cardiol,2022,63:1-7.

[14] Curzen N,Nicholas Z,Stuart B,et al. Fractional flow 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.

[15] Nanna MG,Vemulapalli S,Fordyce CB,et al. The prospective randomized trial of the optimal evaluation of cardiac symptoms and revascularization:rationale and design of the PRECISE trial[J]. Am Heart J,2022,245:136-148.

[16] Morris PD,Ryan D,Morton AC,et al. Virtual fractional flow reserve from coronary angiography:modeling the significance of coronary lesions:results from the VIRTU-1 (VIRTUal Fractional Flow Reserve From Coronary Angiography) study[J]. JACC Cardiovasc Interv,2013,6(2):149-157.

[17] Tu S,Xu L,Ligthart J,et al. In vivo comparison of arterial lumen dimensions assessed by co-registered three-dimensional (3D) quantitative coronary angiography,intravascular ultrasound and optical coherence tomography[J]. Int J Cardiovasc Imaging,2012,28(6):1315-1327.

[18] 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[J]. JACC Cardiovasc Interv,2014,7(7):768-777.

[19] 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[J]. JACC Cardiovasc Interv,2016,9(19):2024-2035.

[20] Westra J,Tu S,Campo G,et al. Diagnostic performance of quantitative flow ratio in prospectively enrolled patients:an individual patient‐data meta‐analysis[J]. Catheter Cardiovasc Interv,2019,94(5):693-701.

[21] Cortés C,Carrasco-Moraleja M,Aparisi A,et al. Quantitative flow ratio—Meta-analysis and systematic review[J]. Catheter Cardiovasc Interv,2021,97(5):807-814.

[22] Xu B,Tu S,Song L,et al. Angiographic quantitative flow ratio-guided coronary intervention (FAVOR Ⅲ China) :a multicentre,randomised,sham-controlled trial[J]. Lancet,2021,398(10317):2149-2159.

[23] 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[J]. EuroIntervention,2019,15(2):189-197.

[24] 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[J]. EuroIntervention,2020,16(7):568-576.

[25] Gutiérrez-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[J]. Cardiol J,2020,27(4):350-361.

[26] 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[J]. Circ J,2020,84(12):2253-2258.

[27] Ding D,Yu W,Tauzin H,et al. Optical flow ratio for assessing stenting result and physiological significance of residual disease[J]. EuroIntervention,2021:17(12):e989-e998.

[28] Yu W,Tanigaki T,Ding D,et al. Accuracy of intravascular ultrasound-based fractional flow reserve in identifying hemodynamic significance of coronary stenosis[J]. Circ Cardiovasc Interv,2021,14(2):e009840.

[29] Roguin A,Abu Dogosh A,Feld Y,et al. Early feasibility of automated artificial intelligence angiography based fractional flow reserve estimation[J]. Am J Cardiol,2021,139:8-14.

[30] Tesche C,de Cecco CN,Baumann S,et al. Coronary CT angiography-derived fractional flow reserve:machine learning algorithm versus computational fluid dynamics modeling[J]. Radiology,2018,288(1):64-72.

[31] Cha JJ,Son TD,Ha J,et al. Optical coherence tomography-based machine learning for predicting fractional flow reserve in intermediate coronary stenosis:a feasibility study[J]. Sci Rep,2020,10(1):20421.

[32] Kurata A,Fukuyama N,Hirai K,et al. On-site computed tomography-derived fractional flow reserve using a machine-learning algorithm-clinical effectiveness in a retrospective multicenter cohort[J]. Circ J,2019,83(7):1563-1571.

[33] von Knebel Doeberitz PL,de Cecco CN,Schoepf UJ,et al. Coronary CT angiography-derived plaque quantification with artificial intelligence CT fractional flow reserve for the identification of lesion-specific ischemia[J]. Eur Radiol,2019,29(5):2378-2387.

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更新日期/Last Update: 2022-12-26