三维定量冠脉造影在冠心病介入治疗中的作用综述

Role of three-dimensional quantitative coronary angiography in percutaneous coronary intervention

长期以来,介入治疗主要依据定量冠状动脉造影(quantitative coronary angiography,QCA)结果作为判断冠状动脉狭窄程度的金标准,同时根据QCA结果,可以确定病变的长度、直径及狭窄程度,决定置入支架的长度和直径。近年来,随着三维定量冠脉造影(three-dimensional quantitative coronary angiography,3DQCA)的推广,越来越多的临床实践显示其对于冠脉狭窄情况、病变血管参数、分叉病变角度的评估以及介入最佳投射角度的推荐较常规的冠脉造影更加准确、可靠。多中心临床试验显示:基于3DQCA的定量血流分数(quantitative blood flow ratio,QFR)与血流储备分数(fractional flow reserve,FFR)较高的一致性,其在冠脉病变功能学及识别心肌缺血方面有良好的诊断效能。本文就3DQCA的基本概念、原理、临床研究进展、优缺点及应用前景进行综述。

The quantitative coronary angiography(QCA)has been the gold standard to evaluate coronary artery stenosis for a long time,and to determine the length and diameter of implanted stent.With the application of three-dimensional quantitative coronary angiography(3 DQCA),more and more clinical practices have shown that 3 DQCA can provide more accurate and reliable assessments of vessel dimensions and geometry for interventional purposes,including lesion length,stenosis severity,bifurcation optimal viewing angles,when compared to conventional coronary angiography.Multicenter studies confirm that the quantitative blood flow fraction(QFR)based on 3 DQCA is in good agreement with FFR,and it is also accurate in determining hemodynamic significance of a lesion and identifying myocardial ischemia.This paper reviews the basic concept,principle,clinical research progress,advantages and disadvantages and application prospect of 3 DQCA.