20 醫學新知 (I) 瞬時無波型比率 (Instantaneous Wave-Free Ratio, ifr) 會接近血流儲備分數 (Fractional Flow Reserve, FFR) 嗎? (Instantaneous Wave-Free Ratio, ifr) (Fractional Flow Reserve, FFR) ifr FFR (diastolic resting myocardial resistance) (mean hyperemic resistance) - Monte Carlo simulation 1129 120-1000 Monte Carlo simulationifr FFR 0.09 ±0.17 2.5±1 (mean hyperemic resistance) - >0.9 ifr FFR ifr FFR (mean hyperemic resistance) ifr ifr FFR (FFR) FAME(FFR ) FFR (ifr) FFR (hyperemia) ifr ifr FFR (resting myocardial diastolic resistance) (mean hyperemic resistance) ifr FFR ifr FFR ifr FFR ifr FFR (simulation model) ifr FFR ifr FFR FFR
醫學新知 (I) 21 ifr FFR - - adenosine hyperemia ifr - ifr FFR ([ifr-ffr]/ FFR x100) ( ) ifr (backpressure) 25% 5 ifr R 2.14.1 ( R ) P <0.05 ifr/ffr 1
22 醫學新知 (I) 1 1000 ifr FFR ( 1A) 1129 ( 1B) ifr FFR ; 0.6 FFR ifr FFR Pearson (r) 0.88(95% [CI] 0.86~0.89 P< 0.001) r 0.82(95%CI 0.80 0.84 P<0.001) 0.90 ± 0.02(P<0.001) 0.90 ± 0.02(P<0.001) 0.15± 0.01(P<0.001) 0.16 ± 0.01(P<0.001) ifr FFR<0.8 ROC 0.95 0.86 ROC 0.89 ifr 0.83 2 Bland-Altman plot ifr FFR 0.09-0.08~+0.26 95% Bland-Altman 1 ifr FFR ifr +0.09 FFR ± 0.17 0.75~0.80 ifr CI 2
醫學新知 (I) 23 3 1
24 醫學新知 (I) 3 ifr ( 3A) adenosine ( 3B) ifr FFR 1 adenosine 99% (0.5% 0.5% ) adenosine ifr 0.74 0.98 76% 96% (2% 2% ) adenosine ifr 0.82~0.96 54% 4 ifr (mean hyperemic resistance) : 4.84 ± 2.55 /( / ) 2.06 ± 0.83 /( / )( t P<0.001) 2.46 ± 1.03 120 11 ( 9%) 10% ifr ifr ifr ( 25% 5 ) ( 4.84 ± 2.55 / / 4.83 ± 2.48 / / ) t p=0.75) ifr (P=0.99) 4
醫學新知 (I) 25 3B 1000 adenosine( Pd/ Pa ) ifr Pd / Pa adenosine ROC ifr 0.86 Pd/Pa 0.87 5 5 1000 ifr ( 1.39-0.39) ± 0.06 95% ( 5 ) (r=0.97 r²=0.95 P<0.001) Pd/ Pa ifr 95%
26 醫學新知 (I) 2 3
醫學新知 (I) 27 2 ifr ifr FFR 3 (R²)>0.90 ifr FFR ifr FFR FFR 2 Bland-Altman ifr FFR +0.09 ifr ± 0.17 FFR ifr FFR ifr FFR 3 1 ifr hyperemia (mean hyperemic resistance) 4 FFR ifr (mean hyperemia) 2.5 FFR ifr ( Pd/ Pa) 3B 1 ifr 5 Pd/ Pa ifr 95% FFR ifr 1A ifr FFR 1B 2 FFR / ifr ifr FFR Monte Carlo simulation 1-3 ifr ifr 1B Bland-Altman +0.09 ± 0.17 +0.05 ± 0.19 +0.09 ± 0.18 ( ifr 3 / )
28 醫學新知 (I) 100% adenosine 90% adenosine adenosine adenosine hyperemia FFR 60 5 hyperemia(ffr >0.05) adenosine 21 FFR adenosine FFR 0.70~0.86 adenosine FFR adenosine ifr ( Pd/ Pa) hyperemia FFR 480 0.86 FFR 0.80 0.88~0.95 adenosine 53% 95% 0.87 46% 0.88~0.95 2.1% 4.1% 94% 123 hyperemia 3 FFR FFR>0.80 0.93 FFR 0.75~0.80 0.88 FFR<0.75 0.84 ifr Monte Carlo simulation 3 R² Monte Carlo simulation 1 ifr FFR ifr FFR<0.80 ifr FFR ifr ifr