Niccoli Giampaolo, Indolfi Ciro, Davies Justin E
Department of Cardiovascular Medicine, Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy.
Division of Cardiology, Department of Medical and Surgical Sciences & URT CNR, Magna Graecia University, Catanzaro, Italy.
Open Heart. 2017 Jun 14;4(2):e000431. doi: 10.1136/openhrt-2016-000431. eCollection 2017.
Fractional flow reserve (FFR) is increasingly used to guide myocardial revascularisation. However, supporting evidence regarding its use originates from studies that have enrolled mainly patients with stable angina, while patients with acute coronary syndromes (ACS) have not been included. Notably, multifactorial microvascular dysfunction and an increased sympathetic tone in patients with ACS may lead to blunted response to adenosine and false-negative results of FFR due to submaximal hyperaemia. This may raise the possibility of deferring treatment of stenosis that instead would have needed dilatation, thus leaving a residual risk of preventable cardiac events. In this literature review, we aim at summarising laboratory and clinical investigations concerning the use of FFR in culprit and non-culprit lesions in ACS. Furthermore, we will report recent data on instantaneous wave-free ratio, an adenosine-free index of functional stenosis severity, in stable coronary artery disease and in patients with ACS.
血流储备分数（FFR）越来越多地用于指导心肌血运重建。然而，关于其应用的支持证据来自主要纳入稳定型心绞痛患者的研究，而急性冠状动脉综合征（ACS）患者未被纳入。值得注意的是，ACS患者的多因素微血管功能障碍和交感神经张力增加可能导致对腺苷的反应减弱以及由于充血不足导致FFR出现假阴性结果。这可能增加延迟治疗本需要扩张的狭窄病变的可能性，从而留下可预防心脏事件的残余风险。在这篇文献综述中，我们旨在总结关于FFR在ACS罪犯病变和非罪犯病变中应用的实验室和临床研究。此外，我们将报告关于瞬时无波比值（一种无腺苷的功能性狭窄严重程度指标）在稳定型冠状动脉疾病和ACS患者中的最新数据。
