Instantaneous wave-free ratio(iFR) to determine hemodynamically significant coronary stenosis: A comprehensive review  

作　　者：Stefan Baumann Leonard Chandra Elizaveta Skarga Matthias Renker Martin Borggrefe Ibrahim Akin Dirk Lossnitzer 

机构地区：[1]First Department of Medicine-Cardiology, University Medical Center Mannheim,Mannheim, Germany and DZHK (German Center for Cardiovascular Research), partner site Heidelberg/Mannheim [2]Department of Cardiology, Kerckhoff-Klinik GmbH

出　　处：《World Journal of Cardiology》2018年第12期267-277,共11页世界心脏病学杂志（英文版）（电子版）

摘　　要：Coronary angiography is considered to be the gold standard in the morphological evaluation of coronary artery stenosis. The morphological assessment of the severity of a coronary lesion is very subjective. Thus, the invasive fractional flow reserve(FFR) measurement represents the current standard for estimation of the hemodynamic significance of coronary artery stenosis. The FFR-guided revascularization strategy was initially classified as a Class-IA-recommendation in the 2014 European Society of Cardiology/European Association for Cardio-Thoracic Surgery guidelines on myocardial revascularization. Both the Deferral vs Performance of Percutaneous Coronary Intervention of Functionally Non-Significant Coronary Stenosis and Flow Reserve vs Angiography for Multivessel Evaluation studies showed no treatment advantage for hemodynamically insignificant stenoses. With the help of FFR(and targeted interventions), clinical results could be improved; however, the use in clinical practice is still limited due to the need of adenosine administration and a significant prolongation of the length of the procedure. Instantaneous wave-free ratio(iFR~) is a new innovative approach for the determination of the hemodynamic significance of coronary stenosis, which can be obtained at rest without the use of vasodilators. Regarding the periprocedural complications as well as prognosis, iFR~ showed non-inferiority to FFR in the SWEDEHEART and DEFINE-FLAIR trials. Furthermore, iFR~, enhanced by iFR~-pullback, provides the possibility to display the iFR~-change over the course of the vessel to create a hemodynamic map.Coronary angiography is considered to be the gold standard in the morphological evaluation of coronary artery stenosis. The morphological assessment of the severity of a coronary lesion is very subjective. Thus, the invasive fractional flow reserve(FFR) measurement represents the current standard for estimation of the hemodynamic significance of coronary artery stenosis. The FFR-guided revascularization strategy was initially classified as a Class-IA-recommendation in the 2014 European Society of Cardiology/European Association for Cardio-Thoracic Surgery guidelines on myocardial revascularization. Both the Deferral vs Performance of Percutaneous Coronary Intervention of Functionally Non-Significant Coronary Stenosis and Flow Reserve vs Angiography for Multivessel Evaluation studies showed no treatment advantage for hemodynamically insignificant stenoses. With the help of FFR(and targeted interventions), clinical results could be improved; however, the use in clinical practice is still limited due to the need of adenosine administration and a significant prolongation of the length of the procedure. Instantaneous wave-free ratio(iFR~) is a new innovative approach for the determination of the hemodynamic significance of coronary stenosis, which can be obtained at rest without the use of vasodilators. Regarding the periprocedural complications as well as prognosis, iFR~ showed non-inferiority to FFR in the SWEDEHEART and DEFINE-FLAIR trials. Furthermore, iFR~, enhanced by iFR~-pullback, provides the possibility to display the iFR~-change over the course of the vessel to create a hemodynamic map.

关 键 词：CORONARY STENOSIS CORONARY ANGIOGRAPHY Fractional flow reserve Instantaneous wave-free RATIO Myocardial ischemia CORONARY REVASCULARIZATION 

分 类 号：R543.3[医药卫生—心血管疾病]