Background:Invasive fractional flow reserve (FFR_INV) is the standard technique for assessing myocardial ischemia. Pressure distortions and measurement location may influence FFR_INV interpretation. We report a technique for performing invasive fractional flow reserve (FFR_INV) by minimizing pressure distortions and identifying the proper location to measure FFR_INV.Methods:FFR_INV recordings were obtained prospectively during manual hyperemic pullback in 100 normal and diseased coronary arteries with single stenosis, using 4 measurements from the terminal vessel, distal-to-the-lesion, proximal vessel, and guiding catheter. FFR_INV profiles were developed by plotting FFR_INV values (y-axis) and site of measurement (x-axis), stratified by stenosis severity. FFR_INV≤0.8 was considered positive for lesion-specific ischemia.Results:Erroneous FFR_INV values were observed in 10% of vessels because of aortic pressure distortion and in 21% because of distal pressure drift; these were corrected by disengagement of the guiding catheter and re-equalization of distal pressure/aortic pressure, respectively. There were significant declines in FFR_INV from the proximal to the terminal vessel in normal and stenotic coronary arteries (P<0.001). The rate of positive FFR_INV was 41% when measured from the terminal vessel and 20% when measured distal-to-the-lesion (P<0.001); 41.5% of positive terminal measurements were reclassified to negative when measured distal-to-the-lesion. Measuring FFR_INV 20 to 30 mm distal-to-the-lesion (rather than from the terminal vessel) can reduce errors in measurement and optimize the assessment of lesion-specific ischemia.Conclusions:Meticulous technique (disengagement of the guiding catheter, FFR_INV pullback) is required to avoid erroneous FFR_INV, which occur in 31% of vessels. Even with optimal technique, FFR_INV values are influenced by stenosis severity and the site of pressure measurement. FFR_INV values from the terminal vessel may overestimate lesion-specific ischemia, leading to unnecessary revascularization.

中文翻译：

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优化侵入性分数血流储备技术以评估特定病变的局部缺血。

背景：有创分数流储备（FFR _INV）是评估心肌缺血的标准技术。压力变形和测量位置可能会影响FFR _INV解释。我们报告用于执行侵入血流储备分数（FFR技术_INV通过最小化压力失真），并确定正确的位置以测量FFR _INV方法：FFR _INV被手动拉回充血过程中100正常前瞻性获得和不健康的冠状动脉与单一狭窄录音，使用来自末端血管，病变远端，近端血管和引导导管的4个测量值。通过绘制FFR _INV来开发FFR _INV配置文件值（y轴）和测量部位（x轴），按狭窄程度进行分层。FFR _INV ≤0.8被认为是阳性的病灶特异性ischemia.Results：错误的FFR _INV中，因为在因为远端压力漂移的21％的主动脉压力失真和容器的10％中观察到的值; 分别通过引导导管的脱离和远端压力/主动脉压力的重新均衡来纠正这些问题。在正常和狭窄冠状动脉中，从近端血管到末端血管的FFR _INV显着下降（P <0.001）。FFR _INV阳性率从末梢血管测量为41％，从远端到病变测量为20％（P <0.001）；当从远端到病变位置测量时，有41.5％的阳性终末测量结果重新分类为阴性。测量FFR _INV 20至30mm远端到所述病变（而不是从终端容器）可以减少测量误差和优化特定病变ischemia.Conclusions的评价：细致的技术（该引导导管，FFR脱离_INV为了避免错误的FFR _INV（发生在31％的船舶中），需要使用“拉回” 。即使采用最佳技术，FFR _INV值也会受到狭窄严重程度和压力测量部位的影响。FFR _INV 末端血管的值可能会高估病变特定的局部缺血，从而导致不必要的血运重建。