Der invasive Ischämienachweis – Fraktionelle Flussreserve (FFR) und Instantaneous Wave Free Ratio (iFR)

Zusammenfassung

Die Bestimmung der fraktionellen Flussreserve (FFR) unter Bedingungen der maximalen Hyperämie – induziert mit Adenosin – im gemessenen koronaren Versorgungsgebiet ist eine einfache und valide Methode zur hämodynamischen Quantifizierung von Koronarstenosen und damit derzeit der Goldstandard zur Therapie-Entscheidung für den invasiv tätigen Kardiologen. Ein Wert≤0,80 stellt eine klare, auch prognostische, Indikation für eine Intervention dar. Bei Werten>0,80 sollte, unter prognostischen Aspekten, auf eine Revaskularisation verzichtet werden. Die Evaluation von Stenosen mit der – Adenosin-freien – instantaneous wave free ratio (iFR) ist ebenfalls möglich bei Patienten, die aufgrund von Kontraindikationen kein Adenosin erhalten dürfen. Aufgrund der geringen diagnostischen Genauigkeit in den aktuellen Studien ist ihr routinemäßiger Einsatz zurzeit aber limitiert.

Abstract

Quantification of hemodynamic relevant coronary lesions under conditions of maximal myocardial hyperemia within the measured territory using fractional flow reserve (FFR) is an easy and highly sensitive method and a well validated and widely used gold standard for decision making in interventional cardiology. FFR value≤0,80 has a clear prognostic impact in favor of interventional therapy. A value>0,80 justifies – with the same prognostic impact – deferral of stent implantation. Evaluation of stenoses with – adenosin free – instantaneous wave free ratio (iFR) is a possible alternative for patients with contraindications for the application of adenosin. Because of the lacking diagnostic accuracy published in actual clinical studies its routinely use is still limited.

Schlüsselwörter

Fraktionale Flussreserve - Instantaneous wave free ratio - Myokardischämie - Koronare Herzkrankheit - Adenosin

Key words

fractional flow reserve - Instantaneous wave free ratio - myocardial ischemia - coronary heart disease - adenosine

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