收稿日期: 2024-03-20
网络出版日期: 2024-11-05
基金资助
国家自然科学基金资助项目(81960066)
The application value and research progress of blood flow reserve fraction based on optical coherence tomography in coronary heart disease
Received date: 2024-03-20
Online published: 2024-11-05
冠心病的患病率逐年上升，死亡率居于首位，早预防、早诊断、早治疗，减少病死率十分重要。冠脉造影是诊断冠心病金标准，在临床应用广泛，但并不能准确地反映冠脉的病变程度。血流储备分数（blood flow reserve fraction， FFR）是目前评价冠状动脉狭窄功能的参考标准。但其是一项有创的检查，操作复杂、价格昂贵、血管扩张药物相关副作用多、可重复性差等诸多因素限制了其在临床上的广泛应用。近年来与影像学相关的无创血流储备分数越来越多的被应用到临床中。定量血流分数（quantitative blood flow fraction， QFR）、基于光学相干断层成像的血流储备分数（OCT-based optical flow ratio， OFR）成为了研究的热点。OFR作为一种较新的技术，受到了越来越多的关注。该文将对上述技术的基本原理、临床价值和研究进展进行描述。
关键词： 血流储备分数; 定量血流分数; 基于光学相干断层成像的血流储备分数; 无创血流储备分数
陆再丽 , 李超中 , 夏洁 , 吴雨竹 , 赵然尊 . 基于光学相干断层成像的血流储备分数在冠心病诊疗中的应用研究进展[J]. 实用医学杂志, 2024 , 40(20) : 2960 -2964 . DOI: 10.3969/j.issn.1006-5725.2024.20.023
The incidence of coronary heart disease is increasing year by year， with the mortality rate ranking first. Early prevention， diagnosis， and treatment are crucial to reduce the mortality rate. Coronary angiography is the gold standard for diagnosing coronary heart disease and is widely used in clinical practice， but it cannot accurately reflect the degree of coronary artery disease. Blood flow reserve fraction （FFR） is currently the reference standard for evaluating coronary artery stenosis function. However， it is an invasive examination that is limited in clinical application due to factors such as complex operation， high cost， multiple side effects related to vasodilators， and poor reproducibility. In recent years， non-invasive blood flow reserve scores related to imaging have been increasingly applied in clinical practice. Quantitative flow fraction （QFR） and optical coherence tomography based flow reserve fraction （OCT based optical flow ratio OFR） have become research hotspots. OFR， as a relatively new technology， has received increasing attention. Therefore， this article will describe the basic principles， clinical value， and research progress of the above-mentioned technologies.
| 1 | PIJLS N H， VAN G B， VAN D V P， et al. A useful index to evaluate the influence of an epicardial coronary stenosis on myocardial blood flow［J］. Circulation，1995， 92（11）：3183-3193. |
| 2 | PIJLS N H， DE B B， PEELS K， et al. Measurement of fractional flow reserve to assess the functional severity of coronary-artery stenoses［J］. N Engl J Med， 1996， 334（26）：1703-1708. doi:10.1056/nejm199606273342604 |
| 3 | ZIMMERMANN F M， FERRARA A， JOHNSON N P， et al. Deferral vs.performance of ercutaneous coronary intervention of functionally non-significant coronary stenosis： 15-year follow-up of the DEFER trial［J］. Eur Heart J， 2015， 36（45）：3182-3188. doi:10.1093/eurheartj/ehv452 |
| 4 | TONIONO P A， DE B B， PIJLS N H， et al.Fractional flow reserve versus angiography for guiding percutaneous coronary intervention［J］. N Engl J Med， 2009， 360（3）：213-224. doi:10.1056/nejmoa0807611 |
| 5 | PIJLS N H， FEARON W F， TONION P A， et al.Fractional flow reserve versus angiography for guiding percutaneous coronary intervention in patients with multivessel coronary artery disease： 2-year follow-up of the FAME （Fractional Flow Reserve Versus Angiography for Multivessel Evaluation） study［J］.J Am Coll Cardiol， 2010， 56（3）：177-184. |
| 6 | LEE J M， KIM H K， PARK K H， et al.Fractional flow reserve versus angiography-guided strategy in acute myocardial infarction with multivessel disease： A randomized trial［J］.Eur Heart J， 2023， 44（6）：473-484. doi:10.1093/eurheartj/ehac763 |
| 7 | TONION P A， DE B B， PIJLS N H， et al. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention［J］. N Engl J Med， 2009， 360（3）：213-224. doi:10.1056/nejmoa0807611 |
| 8 | XAPLANTERIS P， FOURNIER S， PIJLS N H， et al.Five-year outcomes with pci guided by fractional flow reserve［J］.N Engl J Med， 2018， 379（3）：250-259. doi:10.1056/nejmoa1803538 |
| 9 | NEUMANN F J， SOUSA-UVA M， AHLSSON A， et al. 2018 ESC/EACTS Guidelines on myocardial revascularization［J］. Eur Heart J， 2019， 40（2）：87-165. doi:10.1093/eurheartj/ehy855 |
| 10 | 中华医学会心血管病学分会介入心脏病学组，中国医师协会心血管内科医师分会血栓防治专业委员会，中华心血管病杂志编辑委员会.中国经皮冠状动脉介入治疗指南（2016）［J］.中华心血管病杂志， 2016， 44（5）：382-400. |
| 11 | HU F， DING D， WESTRA J， LI Y，et al. Diagnostic accuracy of optical flow ratio： An individual patient-data meta-analysis［J］. Euro Interv， 2023， 19： e14-e54. doi:10.4244/eij-d-22-01098 |
| 12 | DING D， YU W， TANUZIN H， DE M G， et al. Optical flow ratio for assessing stenting result and physiological significance of residual disease［J］. Euro Interv， 2021， 17：e989-e998. doi:10.4244/eij-d-21-00185 |
| 13 | TU S， WESTRA J， YANG J，et al.Diagnostic accuracy of fast computational approaches to derive fractional flow reserve from diagnostic coronary angiography： The international multicenter FAVOR pilot study［J］. JACC Cardiovasc Interv， 2016， 9（19）：2024-2035. doi:10.1016/j.jcin.2016.07.013 |
| 14 | HUANG J， EMORI H， DING D，et al.Diagnostic performance of intracoronaryopti cal coherence tomography-based versus angiography-based fractional flow reserve for the evaluation of coronary lesions［J］. Euro Interv， 2020， 16（7）：568-576. doi:10.4244/eij-d-19-01034 |
| 15 | GUTIERREZ-CHICO J L， WYKRZYKOWSKA J， NUESCH E， et al. Vascular tissue reaction to acute malapposition in human coronary arteries： sequential assessment with optical coherence tomography［J］. Circ Cardiovasc Interv， 2012， 5（1）： 20-29， S1-S8. doi:10.1161/circinterventions.111.965301 |
| 16 | GUTIERREZ-CHICO J L， ALEGRIA-BARRERO E， TEIJEIRO-MESTRE R， et al. Optical coherence tomography： from research to practice［J］. Eur Heart J Cardiovasc Imaging， 2012， 13（5）： 370-384. doi:10.1093/ehjci/jes025 |
| 17 | ALI Z A， MAEHARA A， GENEREUX P， et al. ILUMIEN III： OPTIMIZE PCI Investigators. Optical coherence tomography compared with intravascular ultrasound and with angiography to guide coronary stent implantation （ILUMIEN III： OPTIMIZE PCI）： A randomised controlled trial［J］. Lancet， 2016， 388（10060）： 2618-2628. doi:10.1016/s0140-6736(16)31922-5 |
| 18 | LI Y， GUTIERREZ-CHICO J L， HOLM N R， et al. Impact of side branch modeling on computation of endothelial shear stress in coronary artery disease： coronary tree reconstruction by fusion of 3D angiography and OCT［J］. J Am Coll Cardiol， 2015， 66（2）： 125-135. doi:10.1016/j.jacc.2015.05.008 |
| 19 | YU W， HUANG J， JIA D， et al. Diagnostic accuracy of intracoronary optical coherence tomography-derived fractional flow reserve for assessment of coronary stenosis severity［J］. Euro Interv， 2019， 15（2）：189-197. doi:10.4244/eij-d-19-00182 |
| 20 | TIAN F， YU W， HUANG J， et al.First presentation of integration of intravascular optical coherence tomography and computational fractional flow reserve［J］. Int J Cardiovasc Imaging， 2019， 35（4）：601-602. doi:10.1007/s10554-018-1491-1 |
| 21 | JIANG J， DU C， HU Y， et al. Diagnostic performance of computational fluid dynamics （CFD）-based fractional flow reserve （FFR） derived from coronary computed tomographic angiography （CCTA） for assessing functional severity of coronary lesions［J］. Quant Imaging Med Surg， 2023， 13（3）：1672-1685. doi:10.21037/qims-22-521 |
| 22 | XU B， TU S， QIAO S， et al. Diagnostic accuracy of angiography-based quantitative flow ratio measurements for online assessment of coronary stenosis［J］. J Am Coll Cardiol， 2017， 70（25）：3077-3087. doi:10.1016/j.jacc.2017.10.035 |
| 23 | WESTRA J， ANDERSEN B K， CAMPO G， et al.Diagnostic performance of in-procedure angiography-derived quantitative flow reserve compared to pressure-derived fractional flow reserve： The FAVOR II Europe-Japan study［J］. J Am Heart Assoc， 2018， 7（14）：e009603. doi:10.1161/jaha.118.009603 |
| 24 | WESTRA J， TU S， WINTER S， et al. Evaluation of coronary artery stenosis by quantitative flow ratio during invasive coronary angiography： The WIFI II study （wire-free functional imaging II）［J］. Circ Cardiovasc Imaging， 2018， 11（3）：e007107. doi:10.1161/circimaging.117.007107 |
| 25 | XU B， TU S， SONG L， et al. Angiographic quantitative flow ratio-guided coronary intervention （FAVOR III China）： A multicentre， randomised，sham-controlled trial［J］.Lancet， 2021， 398（10317）：2149-2159. doi:10.1016/s0140-6736(21)02248-0 |
| 26 | CHEN H， LI B， XIAO Y， et al. Diagnostic efficacy of the optical flow ratio in patients with coronary heart disease： A meta-analysis［J］. PLoS One， 2023， 18（5）：e0285508. doi:10.1371/journal.pone.0285508 |
| 27 | HONG H， JIA H， ZENG M， et al. Risk Stratification in Acute Coronary Syndrome by Comprehensive Morphofunctional Assessment With Optical Coherence Tomography［J］. JACC Asia， 2022， 2（4）：460-472. doi:10.1016/j.jacasi.2022.03.004 |
| 28 | KAKIZAKI S， OTAKE H， SEIKE F， et al. Optical coherence tomography fractional flow reserve and cardiovascular outcomes in patients with acute coronary syndrome［J］. JACC Cardiovasc Interv， 2022， 15：2035-2048. doi:10.1016/j.jcin.2022.08.010 |
| 29 | GAO X F， GE Z， KONG X Q， et al. 3-year outcomes of the ultimate trial comparing intravascular ultrasound versus angiography-guided drugeluting stent implantation［J］. JACC Cardiovasc Interv， 2021， 14：247-257. doi:10.1016/j.jcin.2020.10.001 |
| 30 | CSANADI B， FERENCI T， FULOP G，et al. Clinical implications of fractional flow reserve measured immediately after percutaneous coronary intervention［J］. Cardiovasc Drugs Ther， 2023. doi： 10.1007/s10557-023-07437-0 . |
| 31 | STONE G W， MAEHARA A， ALI Z A， et al. Percutaneous coronary intervention for vulnerable coronary atherosclerotic plaque［J］. J Am Coll Cardiol， 2020， 76（20）：2289-2301. doi:10.1016/j.jacc.2020.09.547 |
| 32 | KEDHI E， BERTA B， ROLEDER T，et al. Thin-cap fibroatheroma predicts clinical events in diabetic?patients with normal fractional flow reserve： the COMBINE OCT-FFR trial.［J］ Eur Heart J， 2021， 42（45）：4671-4679. doi:10.1093/eurheartj/ehab433 |
| 33 | MA X， WANG Q， HU X， et al. Association of sdLDL-C with incident carotid plaques with stable and vulnerable morphology： A prospective cohort study［J］. Stroke， 2024， 55（3）：576-585. |
| 34 | 马丽娜，曹振华，杨冰. 小而密低密度脂蛋白胆固醇、CXC型趋化因子配体与糖尿病患者并发心血管疾病的相关性［J］. 实用医学杂志，2023，39（22）：2953-2957. |
| 35 | CHEN Y， FU Y， WANG S， et al.Clinical significance of neutrophil gelatinase-associated lipocalin and sdLDL-C for coronary artery disease in patients with type 2 diabetes mellitus aged?≥?65 years［J］. Cardiovasc Diabetol， 2022， 21（1）：252. doi:10.1186/s12933-022-01668-5 |
| 36 | 巨名飞，刘超，刘佳梅，等. 急性冠状动脉综合征患者残余胆固醇水平与冠状动脉狭窄严重程度的相关性［J］. 实用医学杂志，2023，39（1）：71-75. |
| 37 | TANIGAKI T， EMORI H， KAWASE Y， et al. QFR versus FFR derived from computed tomography for functional assessment of coronary artery stenosis［J］. JACC Cardiovasc Interv， 2019， 12（20）：2050-2059. doi:10.1016/j.jcin.2019.06.043 |
| 38 | ZENG X， HOLCK E N， WESTRA J， et al.Impact of coronary plaque morphology on the precision of computational fractional flow reserve derived from optical coherence tomography imaging［J］. Cardiovasc Diagn Ther， 2022， 12（2）：155-165. doi:10.21037/cdt-21-505 |
| 39 | JIA H， ZHAO C， YU H， et al. Clinical performance of a novel hybrid IVUS-OCT system： A multicentre， randomised， non-inferiority trial （PANOVISION）［J］. Euro Interv， 2023， 19（4）：e318-e320. doi:10.4244/eij-d-22-01058 |
| 40 | EMORI H， KUBO T， SHIONO Y， et al. Comparison of optical flow ratio and fractional flow ratio in stent-treated arteries immediately after percutaneous coronary intervention［J］. Circ J， 2020， 84（12）：2253-2258. doi:10.1253/circj.cj-20-0661 |
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