Takami Yoshiyuki, Maekawa Atsuo, Yamana Koji, Akita Kiyotoshi, Amano Kentaro, Niwa Wakana, Matsuhashi Kazuki, Takagi Yasushi
Department of Cardiovascular Surgery, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake, Toyoake 470-1192, Aichi, Japan.
J Cardiovasc Dev Dis. 2025 Jan 2;12(1):16. doi: 10.3390/jcdd12010016.
Fractional flow reserve (FFR) has been well validated as a modality for evaluating myocardial ischemia, demonstrating the superiority of FFR-guided percutaneous coronary intervention (PCI) over conventional angiography-guided PCI. As a result, the strategy for coronary artery bypass grafting (CABG) is shifting toward FFR guidance. However, the advantage of FFR-guided CABG over angiography-guided CABG remains unclear. While FFR-guided CABG can help avoid unnecessary grafting in cases of moderate stenosis, it may also carry the risk of incomplete revascularization. The limited use of FFR due to the need for hyperemia has led to the development of non-hyperemic pressure ratios (NHPRs). NHPR pullback provides trans-stenotic pressure gradients, which may offer valuable insights for CABG strategies. Recently, computed tomographic coronary angiography (CTCA) has emerged as a non-invasive modality that provides accurate data on lesion length, diameter, minimum lumen area, percentage stenosis, and the volume and distribution of high-risk plaques. With the introduction of FFR-CT, CTCA is now highly anticipated to provide both functional evaluation (of myocardial ischemia) via FFR-CT and anatomical information through serial quantitative assessment. Beyond the diagnostic phase, CTCA, augmented by automatic artificial intelligence, holds great potential for guiding therapeutic interventions in the future.
血流储备分数（FFR）已被充分验证为评估心肌缺血的一种方法，显示出FFR指导的经皮冠状动脉介入治疗（PCI）优于传统血管造影指导的PCI。因此，冠状动脉旁路移植术（CABG）的策略正朝着FFR指导转变。然而，FFR指导的CABG相对于血管造影指导的CABG的优势仍不明确。虽然FFR指导的CABG可以帮助避免在中度狭窄病例中进行不必要的移植，但它也可能存在血运重建不完全的风险。由于需要充血，FFR的使用受限，这导致了非充血压力比值（NHPRs）的发展。NHPR回撤提供跨狭窄压力梯度，这可能为CABG策略提供有价值的见解。最近，计算机断层扫描冠状动脉造影（CTCA）已成为一种非侵入性方法，可提供有关病变长度、直径、最小管腔面积、狭窄百分比以及高危斑块的体积和分布的准确数据。随着FFR-CT的引入，现在人们高度期望CTCA既能通过FFR-CT提供（心肌缺血的）功能评估，又能通过系列定量评估提供解剖学信息。在诊断阶段之外，由自动人工智能增强的CTCA在未来指导治疗干预方面具有巨大潜力。
