#16
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Цитата:
Подскажите, помимо упомянутых в данной теме DEFER, FAME, FAME II существуют ли какие-либо ещё исследования по применению FFR? Спасибо! |
#17
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Есть различные исследования, посвященные использованию FFR в клинической практике: при бифуркационных поражениях, при наличии нескольких стенозов в разных сегментах одной коронарной артерии. На мой взгляд, заслуживает внимания исследование, посвященное измерению FFR при наличии изолированного стеноза в проксимальном сегменте ПНА - 730 пациентов и 5-ти летний follow-up. Прикрепляю...
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#18
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Цитата:
Malcolm R. Bell3, David R. Holmes3, John F. Bresnahan3, Charanjit S. Rihal3, Lilach O. Lerman6, and Amir Lerman3"Long-term outcomes of fractional flow reserve-guided vs. angiography-guided percutaneous coronary intervention in contemporary practice" European Heart Journal (2013) 34, 1375–1383 Exclusion criteria included presentation with ST-segment elevated myocardial infarction (MI) or cardiogenic shock; referral for coronary artery bypass surgery; or patient refusal to allow the use of their records for research purposes. The study followed the principles of the Declaration of Helsinki and was approved by the Institutional Review Board of the Mayo Clinic. Sanjiv Kaul, MD, FACC, Ananda R. Jayaweera, PHD"Myocardial Capillaries and Coronary Flow Reserve*"JACC Vol. 52, No. 17, 2008 October 21, 1399–401 The general assumption among cardiologists is that myocardial ischemia occurs only in the presence of obstructive coronary artery disease. This is based on the misconception that abnormal coronary flow reserve (CFR) is associated only with coronary stenosis and results from the increased resistance offered by the stenosis... There are many cardiac conditions that affect capillary structure and function as well as microvascular rheology. This must be kept in mind when assessing the clinical and prognostic implications of reduced CFR in individual patients... |
#19
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Ntalianis A, Sels JW, Davidavicius G, et al, Fractional flow reserve for the assessment of nonculprit coronary artery stenoses in patients with acute myocardial infarction.JACC Cardiovasc Interv. 2010 Dec;3(12):1274-81. doi: 10.1016/j.jcin.2010.08.025.
CONCLUSIONS: During the acute phase of acute coronary syndromes, the severity of nonculprit coronary artery stenoses can reliably be assessed by FFR. This allows a decision about the need for additional revascularization and might contribute to a better risk stratification. |
#20
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Цитата:
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#21
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Если я правильно Вас понял, " There are many cardiac conditions that affect capillary structure and function as well as microvascular rheology. This must be kept in mind when assessing the clinical and prognostic implications of reduced CFR in individual patients..." относится только к CFR, а к FFR не относится?
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#22
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Цитата:
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#23
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#24
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Цитата:
[Ссылки доступны только зарегистрированным пользователям ] |
#25
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Цитата:
- enrolled 200 patients at 10 UK centers - As Curzen showed during today's hot-line session, a full 26% of patients had their treatment plans changed following the FFR results - "It's very clear that the more pressure wire you do, the less stenting you do. And in fact, one of the reasons FFR hasn't spread more widely around the world is that doctors don't want the FFR results, because it might tell them they shouldn't put a stent in, and that's a disincentive." - "If a randomized trial shows the same results as RIPCORD, that may well be the end of noninterventional cardiologists doing diagnostic angiography," |
#26
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Цитата:
[Ссылки доступны только зарегистрированным пользователям ] Intern Med. 2011;50(22):2811-3. Epub 2011 Nov 15. A pitfall of fractional flow reserve associated with the presence of collateral circulation. An 82-year-old man had a severe stenosis in the proximal left anterior descending artery (LAD) and an intermediate stenosis in the distal right coronary artery (RCA). The territory of mid to distal LAD was perfused via an angiographically well-developed collateral circulation from the distal RCA. Fractional flow reserve (FFR) in the distal RCA was 0.84. After successful coronary intervention for the proximal LAD, repeat FFR in the distal RCA was 0.96. In this case, the severity of the stenosis in the donor artery was overestimated by using FFR due to the presence of well-developed collateral circulation. А к коллатералям еще и очаговый кардиосклероз (как Вы показали мне ранее)? Или я слишком усложняю ситуацию? |
#27
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Цитата:
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#28
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Еще одна иллюстрация...
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#29
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Цитата:
[Ссылки доступны только зарегистрированным пользователям ] Limitations Although recruitable collateral flow in the porcine coronary system is similar to human coronaries, this study is limited by its use of an acute animal model with normal microvascular function.17,18 Furthermore, the epicardial artery stenoses were created acutely. It is possible that microvascular dysfunction or chronic stenoses might have a different impact on changes in microvascular resistance with epicardial stenoses. Moreover, we did not specifically assess changes in capillary resistance that might occur with creation of epicardial stenoses. Kaul and colleagues19 and Jayaweera et al20 have demonstrated the importance of the capillary system in determining microvascular resistance; a more comprehensive hemodynamic assessment, including an evaluation of changes in capillary resistance, will be necessary to validate our findings. The slope of IMR as stenosis severity increased was slightly positive, while the slope of Rmicro was slightly negative. Theoretically, the slopes should be zero; the slight deviation was statistically insignificant and presumably a result of measurement variation. The most severe stenoses in this study did not affect resting flow. The effect on the microvasculature of this subset of extreme stenoses requires further study. Понятно, что без проверки на животных здесь не обойтись, однако различия между острой пробой с изменением кровотока и его изменением при хроническом состоянии (стеноза) могут отличаться значительно, в том числе и по коллатеральному кровотоку. Быть может на эту тему у Вас есть более "свежие" данные. Буду крайне признателен (в пределах возможного) |
#30
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Цитата:
[Ссылки доступны только зарегистрированным пользователям ] [Ссылки доступны только зарегистрированным пользователям ] |