Ilic Ivan, Timcic Stefan, Odanovic Natalija, Otasevic Petar, Collet Carlos
Institute for Cardiovascular Diseases Dedinje, Belgrade, Serbia.
Medical School, University of Belgrade, Belgrade, Serbia.
Front Cardiovasc Med. 2023 May 2;10:1172906. doi: 10.3389/fcvm.2023.1172906. eCollection 2023.
Atherosclerosis is a widespread disease affecting coronary arteries. Diffuse atherosclerotic disease affects the whole vessel, posing difficulties in determining lesion significance by angiography. Research has confirmed that revascularization guided by invasive coronary physiology indices improves patients' prognosis and quality of life. Serial lesions can be a diagnostic challenge because the measurement of functional stenosis significance using invasive physiology is influenced by a complex interplay of factors. The use of fractional flow reserve (FFR) pullback provides a trans-stenotic pressure gradient (P) for each of the lesions. The strategy of treating the lesion with greater P first and then reevaluating another lesion has been advocated. Similarly, non-hyperemic indices can be used to assess the contribution of each stenosis and predict the effect of lesion treatment on physiology indices. Pullback pressure gradient (PPG) integrates physiological variables of coronary pressure along the epicardial vessel and characteristics of discrete and diffuse coronary stenoses into a quantitative index that can be used to guide revascularization. We proposed an algorithm that integrates FFR pullbacks and calculates PPG to determine individual lesion importance and to guide intervention. Computer modeling of the coronaries and the use of non-invasive FFR measurement together with mathematical algorithms for fluid dynamics can make predictions of lesion significance in serial stenoses easier and provide practical solutions for treatment. All these strategies need to be validated before widespread clinical use.
动脉粥样硬化是一种影响冠状动脉的广泛疾病。弥漫性动脉粥样硬化疾病累及整个血管，通过血管造影确定病变的重要性存在困难。研究证实，以有创冠状动脉生理学指标为指导的血运重建可改善患者的预后和生活质量。串联病变可能是一个诊断挑战，因为使用有创生理学方法测量功能性狭窄的重要性会受到多种因素复杂相互作用的影响。使用血流储备分数（FFR）回撤可为每个病变提供跨狭窄压力梯度（P）。有人主张先处理P值较大的病变，然后再重新评估另一个病变的策略。同样，非充血指标可用于评估每个狭窄的作用，并预测病变治疗对生理学指标的影响。回撤压力梯度（PPG）将沿心外膜血管的冠状动脉压力生理变量以及离散和弥漫性冠状动脉狭窄的特征整合为一个可用于指导血运重建的定量指标。我们提出了一种算法，该算法整合FFR回撤并计算PPG，以确定单个病变的重要性并指导干预。冠状动脉的计算机建模以及无创FFR测量与流体动力学数学算法的结合，可以使串联狭窄病变重要性的预测更容易，并为治疗提供切实可行的解决方案。所有这些策略在广泛临床应用之前都需要进行验证。
