Physiological basis of clinically used coronary hemodynamic indices
Physiological basis of clinically used coronary hemodynamic indices
复制标题
DOI：
10.1161/circulationaha.105.587196
复制
发表时间：
2006-01-24
期刊：
影响因子：
37.8
通讯作者：
Siebes, M
中科院分区：
文献类型：
--
作者：
Spaan, JAE;Piek, JJ;Siebes, M
在推导临床使用的血流动力学指标（例如血流储备分数和冠状动脉血流速度储备）时，使用了冠状循环的简化模型。特别是，心肌阻力被认为与心脏收缩和驱动压力等因素无关。这些简化的假设并不总是合理的。在这篇综述中，我们重点关注阻力血管的扩张性、冠状动脉压力血流线的形状以及侧支血流对这些线的影响。我们证明：（1）冠状动脉系统本质上是非线性的，因为最大血管舒张时的阻力血管会随着压力和心脏功能而改变直径； (2) 不需要侧支流量的假设来解释压力导出的分数流量储备和流量导出的分数流量储备之间的差异； (3)侧支流仅在远端压力较低时发挥作用。我们的结论是，传统的血流动力学指标对于临床决策很有价值，但冠状动脉生理学的临床研究将从冠状动脉流量或速度和压力的组合测量中受益匪浅。
In deriving clinically used hemodynamic indices such as fractional flow reserve and coronary flow velocity reserve, simplified models of the coronary circulation are used. In particular, myocardial resistance is assumed to be independent of factors such as heart contraction and driving pressure. These simplifying assumptions are not always justified. In this review we focus on distensibility of resistance vessels, the shape of coronary pressure-flow lines, and the influence of collateral flow on these lines. We show that (1) the coronary system is intrinsically nonlinear because resistance vessels at maximal vasodilation change diameter with pressure and cardiac function; (2) the assumption of collateral flow is not needed to explain the difference between pressure-derived and flow-derived fractional flow reserve; and (3) collateral flow plays a role only at low distal pressures. We conclude that traditional hemodynamic indices are valuable for clinical decision making but that clinical studies of coronary physiology will benefit greatly from combined measurements of coronary flow or velocity and pressure.