Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.
Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Nat Rev Cardiol. 2020 Oct;17(10):629-640. doi: 10.1038/s41569-020-0374-z. Epub 2020 May 14.
Evidence supporting the use of coronary physiology as an adjunct to coronary angiography to guide percutaneous coronary interventions has accumulated over the past 25 years. The fractional flow reserve has dominated this evolving physiological guidance of coronary intervention and its use is supported by large clinical outcome trials. However, despite clinical practice guidelines advocating its use in most patients with coronary stenosis who are eligible for coronary intervention, the uptake of a physiology-guided approach remains limited. The use of non-hyperaemic coronary pressure measurements to guide coronary interventions was introduced in an attempt to simplify the routine application of coronary physiology-guided intervention in daily practice. Over the past decade, a large scientific effort has focused on the development of several non-hyperaemic pressure ratios. In this Review, we detail the basic principles of coronary physiology in non-hyperaemic conditions, the rationale for the use of non-hyperaemic coronary pressure measurements for stenosis evaluation, the current evidence base for the available non-hyperaemic coronary pressure ratios, the basis for the discordance between non-hyperaemic coronary pressure ratios and fractional flow reserve, and the potential advantages of these new parameters over fractional flow reserve.
在过去的 25 年中，积累了越来越多的证据支持将冠状动脉生理学作为辅助手段用于冠状动脉造影以指导经皮冠状动脉介入治疗。血流储备分数在这一不断发展的冠状动脉介入生理学指导中占据主导地位，其应用得到了大型临床结局试验的支持。然而，尽管临床实践指南主张将其用于大多数适合冠状动脉介入治疗的冠状动脉狭窄患者，但生理学指导方法的应用仍然有限。为了简化在日常实践中对冠状动脉生理学指导介入的常规应用，引入了非充血性冠状动脉压力测量来指导冠状动脉介入。在过去的十年中，大量的科学努力集中在开发几种非充血性压力比上。在这篇综述中，我们详细介绍了非充血条件下冠状动脉生理学的基本原理、非充血性冠状动脉压力测量用于狭窄评估的原理、现有非充血性冠状动脉压力比的证据基础、非充血性冠状动脉压力比与血流储备分数之间的不匹配的基础，以及这些新参数相对于血流储备分数的潜在优势。
