Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, 1400 Pelham Parkway South, Bronx, NY 10461, USA.
Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 210th Street, Bronx, NY 10467, USA.
J Cardiol. 2022 Jan;79(1):71-78. doi: 10.1016/j.jjcc.2021.07.009. Epub 2021 Aug 9.
Despite the current evidence supporting clinical benefits of fractional flow reserve (FFR), its uptake in the cardiac catheterization laboratory has been slow due to procedural cost and increased time with the need for maximum hyperemia. Recently, novel physiological indices derived from coronary angiography and intracoronary imaging have emerged to overcome issues with a wire-based FFR. Angiography-based FFR can be measured without vessel instrumentation and has shown excellent diagnostic performance using wire-based FFR as the reference standard. Thus, angiography-based FFR may facilitate coronary functional assessment before and after percutaneous coronary intervention (PCI). Angiography-based index of microcirculatory resistance (IMR) is another new computational index for assessing the coronary microcirculation. Although angiography-derived IMR remains in an early phase of development and requires further validation, its less-invasive nature may help broaden the adoption of microvascular functional assessment in various conditions such as myocardial infarction and cardiac allograft vasculopathy. Lastly, computational FFR based on intravascular ultrasound and optical coherence tomography allows detailed lesion assessment from both morphological and functional standpoints. Given a growing interest in physiology-guided PCI optimization strategies, intravascular imaging-based FFR may become the main assessment tool to confirm successful PCI.
尽管目前有证据支持分数血流储备（FFR）的临床获益，但由于程序成本增加和需要最大限度充血导致的时间延长，其在心脏导管实验室的应用进展缓慢。最近，从冠状动脉造影和冠状动脉内成像中衍生出了新的生理学指标，以克服基于导丝的 FFR 的问题。基于造影的 FFR 可以在不进行血管器械检查的情况下进行测量，并且使用基于导丝的 FFR 作为参考标准显示出出色的诊断性能。因此，基于造影的 FFR 可以在经皮冠状动脉介入治疗（PCI）前后促进冠状动脉功能评估。基于造影的微血管阻力指数（IMR）是另一种用于评估冠状动脉微循环的新计算指标。尽管基于造影的 IMR 仍处于早期开发阶段，需要进一步验证，但它的微创性可能有助于在心肌梗死和心脏移植血管病等各种情况下更广泛地采用微血管功能评估。最后，基于血管内超声和光学相干断层扫描的计算 FFR 允许从形态和功能角度对病变进行详细评估。鉴于人们对生理学指导的 PCI 优化策略的兴趣日益浓厚，基于血管内成像的 FFR 可能成为确认成功 PCI 的主要评估工具。
