Nijjer Sukhjinder S, Sen Sayan, Petraco Ricardo, Davies Justin Er
International Centre of Circulatory Health, Imperial College London.
Circ J. 2015;79(6):1172-84. doi: 10.1253/circj.CJ-15-0044. Epub 2015 Apr 13.
Pressure-wire technology, most typically fractional flow reserve (FFR), has provided interventional cardiologists with a means of determining the physiological importance of a stenosis during angiography. There has been renewed interest in coronary physiology in the light of guideline recognition, ongoing clinical research and new technologies changing the paradigm of how assessment is performed in the catheter laboratory. We reflect on FFR, with regards the potential effects of changing hemodynamics on FFR and the latest evidence with regards to outcomes. We also review the instantaneous wave-free ratio (iFR), a new pressure-only index, measured at rest, that is under active evaluation in several international randomized controlled trials. We review the accumulated evidence and discuss the important physiological concepts between pressure and flow that underlie the approach to using resting indices. Finally we investigate future developments, including physiological mapping with iFR-Pullback and the potential to predict the hemodynamic effect of stenting.
压力导丝技术，最典型的是血流储备分数（FFR），为介入心脏病学家提供了一种在血管造影过程中确定狭窄病变生理重要性的方法。鉴于指南的认可、正在进行的临床研究以及改变导管室评估方式的新技术，人们对冠状动脉生理学重新产生了兴趣。我们思考FFR，考虑血流动力学变化对FFR的潜在影响以及关于预后的最新证据。我们还回顾了瞬时无波比值（iFR），这是一种仅基于压力的新指标，在静息状态下测量，目前正在多项国际随机对照试验中进行积极评估。我们回顾了积累的证据，并讨论了压力与流量之间重要的生理概念，这些概念是使用静息指标方法的基础。最后，我们探讨未来的发展，包括使用iFR回撤进行生理标测以及预测支架置入血流动力学效应的潜力。
