Poon Eric K W, Hayat Umair, Thondapu Vikas, Ooi Andrew S H, Ul Haq Muhammad Asrar, Moore Stephen, Foin Nicolas, Tu Shengxian, Chin Cheng, Monty Jason P, Marusic Ivan, Barlis Peter
aDepartment of Mechanical Engineering, Melbourne School of Engineering bNorth West Academic Centre, Melbourne Medical School cIBM Research Collaboratory for Life Sciences-Melbourne, Victoria Life Sciences Computation Initiative, The University of Melbourne, Melbourne, Victoria, Australia dNational Heart Research Institute Singapore, National Heart Centre Singapore, Singapore eBiomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China.
Coron Artery Dis. 2015 Aug;26 Suppl 1:e43-54. doi: 10.1097/MCA.0000000000000219.
Percutaneous coronary intervention (PCI) has shown a high success rate in the treatment of coronary artery disease. The decision to perform PCI often relies on the cardiologist's visual interpretation of coronary lesions during angiography. This has inherent limitations, particularly due to the low resolution and two-dimensional nature of angiography. State-of-the-art modalities such as three-dimensional quantitative coronary angiography, optical coherence tomography and invasive fractional flow reserve (FFR) may improve clinicians' understanding of both the anatomical and physiological importance of coronary lesions. While invasive FFR is the gold standard technique for assessment of the haemodynamic significance of coronary lesions, recent studies have explored a surrogate for FFR derived solely from three-dimensional reconstruction of the invasive angiogram, and therefore eliminating need for a pressure wire. Utilizing advanced computational fluid dynamics research, this virtual fractional flow reserve (vFFR) has demonstrated reasonable correlation with invasive measurements and remains an intense area of ongoing study. However, at present, several limitations and computational fluid dynamic assumptions may preclude vFFR from widespread clinical use. This review demonstrates the tight integration of advanced three-dimensional imaging techniques and vFFR in assessing coronary artery disease, reviews the advantages and disadvantages of such techniques and attempts to provide a glimpse of how such advances may benefit future clinical decision-making during PCI.
经皮冠状动脉介入治疗（PCI）在冠心病治疗中已显示出较高的成功率。是否进行PCI的决策通常依赖于心脏病专家在血管造影过程中对冠状动脉病变的视觉解读。这存在固有的局限性，尤其是由于血管造影的分辨率低和二维特性。诸如三维定量冠状动脉造影、光学相干断层扫描和有创血流储备分数（FFR）等先进技术可能会提高临床医生对冠状动脉病变的解剖学和生理学重要性的理解。虽然有创FFR是评估冠状动脉病变血流动力学意义的金标准技术，但最近的研究探索了一种仅从有创血管造影的三维重建中得出的FFR替代方法，从而无需使用压力导丝。利用先进的计算流体动力学研究，这种虚拟血流储备分数（vFFR）已显示出与有创测量有合理的相关性，并且仍然是一个正在深入研究的领域。然而，目前，一些局限性和计算流体动力学假设可能会阻碍vFFR在临床中的广泛应用。本综述展示了先进的三维成像技术和vFFR在评估冠状动脉疾病中的紧密结合，回顾了这些技术的优缺点，并试图简要介绍这些进展如何可能有益于未来PCI过程中的临床决策。
