Johnson Nils P, Gould K Lance
McGovern Medical School at UTHealth, Memorial Hermann Hospital, Houston, Texas, US.
Methodist Debakey Cardiovasc J. 2025 Aug 12;21(4):4-13. doi: 10.14797/mdcvj.1606. eCollection 2025.
Given the large amount of myocardium supplied by the left anterior descending (LAD) artery, it understandably receives additional scrutiny during coronary angiography. However, these same features make the interpretation of pressure wire physiology more nuanced to avoid overtreatment. This review provides case examples to underpin an extensive literature review supporting the argument that a "positive" fractional flow reserve (FFR) in the LAD needs to be approached with caution. A large hyperemic gradient, or low FFR, can arise from either a severe and focal lesion in conjunction with low flow or diffuse disease coupled with intact or normal flow. Separating these two scenarios, and the wide continuum between them, ultimately requires upstream assessment of absolute myocardial perfusion, although a pressure wire pullback can help identify diffuse patterns unsuitable for revascularization.
鉴于左前降支（LAD）动脉供血的心肌量很大，在冠状动脉造影期间对其进行额外检查是可以理解的。然而，这些相同的特征使得压力导丝生理学的解释更加微妙，以避免过度治疗。本综述提供了案例示例，以支持广泛的文献综述，该综述支持这样的观点，即对于LAD中“阳性”的血流储备分数（FFR）需要谨慎对待。大的充血梯度或低FFR可能源于严重的局灶性病变合并低血流，或者弥漫性疾病合并完整或正常血流。区分这两种情况以及它们之间的广泛连续体，最终需要对绝对心肌灌注进行上游评估，尽管压力导丝回撤有助于识别不适合血运重建的弥漫性模式。
