Virtual (Computed) Fractional Flow Reserve: Future Role in Acute Coronary Syndromes

Frontiers in Cardiovascular Medicine

Gareth Williams²  Rebecca Gosling²  Giulia Pederzani²  Rodney Hose²  Patricia V. Lawford²  Mina Ghobrial²  Vignesh Rammohan²  Julian P. Gunn³  Hazel Arfah Haley³  Mark T. Mills³  Paul D. Morris³  Tom Newman³ 

[1] Department of Infection Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom;Insigneo Institute for in silico Medicine, Sheffield, United Kingdom;Sheffield Teaching Hospitals National Health Service Foundation Trust, Sheffield, United Kingdom;

关键词: computed blood flow;    ACS - ACS/NSTEMI;    FFR;    vFFR;    virtual FFR;    angiogram based FFR;   

DOI  :  10.3389/fcvm.2021.735008

来源: DOAJ

【 摘 要 】

The current management of acute coronary syndromes (ACS) is with an invasive strategy to guide treatment. However, identifying the lesions which are physiologically significant can be challenging. Non-invasive imaging is generally not appropriate or timely in the acute setting, so the decision is generally based upon visual assessment of the angiogram, supplemented in a small minority by invasive pressure wire studies using fractional flow reserve (FFR) or related indices. Whilst pressure wire usage is slowly increasing, it is not feasible in many vessels, patients and situations. Limited evidence for the use of FFR in non-ST elevation (NSTE) ACS suggests a 25% change in management, compared with traditional assessment, with a shift from more to less extensive revascularisation. Virtual (computed) FFR (vFFR), which uses a 3D model of the coronary arteries constructed from the invasive angiogram, and application of the physical laws of fluid flow, has the potential to be used more widely in this situation. It is less invasive, fast and can be integrated into catheter laboratory software. For severe lesions, or mild disease, it is probably not required, but it could improve the management of moderate disease in 'real time' for patients with non-ST elevation acute coronary syndromes (NSTE-ACS), and in bystander disease in ST elevation myocardial infarction. Its practicability and impact in the acute setting need to be tested, but the underpinning science and potential benefits for rapid and streamlined decision-making are enticing.

【 授权许可】

Unknown