Publication: Inducción de hiperemia en la determinación invasiva de la reserva fraccional de flujo
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2017-02-14
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Universidad Complutense de Madrid
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Abstract
El FFR (siglas en inglés de la reserva fraccional de flujo) se ha convertido los últimos años en la modalidad de valoración fisiológica de la circulación coronaria con mayor aplicación clínica y constituye el objetivo de investigación de esta tesis.Al igual que otras técnicas de diagnóstico intracoronario, el FFR se desarrolló buscando una solución alternativa a las limitaciones de la angiografía como técnica de valoración de la circulación coronaria.La interpretación visual de la coronariografía es el método más ampliamente utilizado para evaluar la severidad de las estenosis coronarias, sin embargo no proporciona información funcional sobre dichas estenosis que es de gran utilidad para la toma de decisiones clínicas. Vamos a revisar algunos conceptos básicos sobre la circulación coronaria y los fundamentos teóricos de la guía de presión, para poder comprender su utilidad como herramienta en la valoración funcional de las estenosis coronarias.El árbol arterial coronario desde el punto de vista funcional puede dividirse en dos compartimentos , uno de conductancia constituido por las arterias coronarias epicárdicas y otro de resistencia representado por las arteriolas y los capilares .La microcirculación coronaria tiene como papel fundamental asegurar un aporte adecuado de flujo sanguineo al miocárdio mediante diferentes mecanismos en función de las condiciones fisiológicas cambiantes. Está formada por pre-arteriolas y arteriolas (diámetro inferior a 100 micras) que son las responsables en mayor parte del control de la resistencia coronaria...
During the past decade, the physiological assessment of coronary artery disease has become increasingly important in both clinical and research applications. Even though coronary angiography is still the most used tool in the diagnosis of coronary artery disease, it has a major limitation that it cannot fully characterize the clinical significance of coronary stenosis. Even with numerous angiographic angulations to reveal the lesion in its best view , the significance of coronary stenosis, especially for an intermediate narrowing (40-70% diameter narrowing) can not be accurately determined.Measurements of coronary pressure and flow provide information complementary to the anatomic characterization of coronary artery disease.Such physiological data obtained during the angiographic procedure can facilitate and make more objective the decisions about the best convenient therapy .A brief review of coronary flow and pressure will be helpful for our work. The coronary artery circulation is composed of epicardial vessels, small arteries arterioles and the capillary system. The epicardial coronary arteries are called conductance vessels , they do not create any significant resistance to blood flow. The arteries of less than 400μm are also called the resistive vessels, adjustment of coronary resistance occurs principally at this point. Resistive vessels are able to vasodilate under physiological and pharmacological stress. This modulation of resistance is important for matching myocardial blood flow to variable energy requirements...
During the past decade, the physiological assessment of coronary artery disease has become increasingly important in both clinical and research applications. Even though coronary angiography is still the most used tool in the diagnosis of coronary artery disease, it has a major limitation that it cannot fully characterize the clinical significance of coronary stenosis. Even with numerous angiographic angulations to reveal the lesion in its best view , the significance of coronary stenosis, especially for an intermediate narrowing (40-70% diameter narrowing) can not be accurately determined.Measurements of coronary pressure and flow provide information complementary to the anatomic characterization of coronary artery disease.Such physiological data obtained during the angiographic procedure can facilitate and make more objective the decisions about the best convenient therapy .A brief review of coronary flow and pressure will be helpful for our work. The coronary artery circulation is composed of epicardial vessels, small arteries arterioles and the capillary system. The epicardial coronary arteries are called conductance vessels , they do not create any significant resistance to blood flow. The arteries of less than 400μm are also called the resistive vessels, adjustment of coronary resistance occurs principally at this point. Resistive vessels are able to vasodilate under physiological and pharmacological stress. This modulation of resistance is important for matching myocardial blood flow to variable energy requirements...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Medicina, leída el 09-02-2016