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Fraktionelle Flussreserve in der Diagnostik der koronaren Herzerkrankung

Klinische Bedeutung, Durchführung und Interpretation

Fractional flow reserve in the diagnostics of coronary artery disease

Clinical importance, performance and interpretation

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Der Kardiologe Aims and scope

Zusammenfassung

Die invasive Bestimmung der fraktionellen Flussreserve („fractional flow reserve“, FFR) gestattet die Ermittlung der hämodynamischen Relevanz von Stenosen der Koronararterien. Verschiedene Studien konnten nachweisen, dass die Indikationsstellung zur myokardialen Revaskularisation, basierend auf den Ergebnissen einer FFR-Messung, mit einem verbesserten Outcome verbunden ist im Vergleich zur rein visuellen Quantifizierung des Schweregrades einer Stenose. Dies hat dazu geführt, dass die FFR-Messung Eingang in die Leitlinien gefunden hat. Die vorliegende Arbeit zeigt den theoretischen Hintergrund der FFR-Messung auf, fasst die entscheidenden klinischen Daten zusammen und bietet eine umfassende Praxisanleitung für die sichere und schnelle Durchführung der Messung im klinischen Alltag.

Abstract

Invasive measurement of the fractional flow reserve (FFR) allows determination of the hemodynamic relevance of a given coronary artery stenosis. Several clinical trials could demonstrate the superiority of FFR-based decision-making for or against percutaneous coronary intervention (PCI) in comparison to visual quantification of the severity of a stenosis. These results led to measurement of the FFR being included in the current guideline recommendations on myocardial revascularization. This article elaborates the theoretical background of measurement of the FFR, summarizes the decisive clinical data and provides comprehensive practical instructions for the safe and rapid measurement of FFR in routine clinical practice.

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Authors and Affiliations

  1. Medizinische Klinik 1, St. Johannes-Hospital Dortmund, Johannesstr. 9–13, 44137, Dortmund, Deutschland

    H. Möllmann

  2. Medizinische Klinik 3, Universitätsklinikum Köln, Köln, Deutschland

    T. Rudolph

  3. Herzzentrum, Städtisches Klinikum München GmbH, München, Deutschland

    J. Rieber

  4. Cardioangiologisches Centrum Bethanien, Frankfurt, Deutschland

    H. Eggebrecht

  5. Herzzentrum, Segeberger Kliniken, Bad Segeberg, Deutschland

    G. Richardt

  6. Contilia Herz- und Gefäßzentrum, Essen, Deutschland

    T. Schmitz

  7. Medizinische Klinik und Poliklinik 2, Universitätsklinikum Bonn, Bonn, Deutschland

    N. Werner

  8. Medizinische Klinik 2, Universitätsklinikum Erlangen, Erlangen, Deutschland

    S. Achenbach

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  1. H. Möllmann
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Correspondence to H. Möllmann.

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Interessenkonflikt

H. Möllmann: Referentenhonorar und Proctortätigkeit St. Jude Medical. J. Rieber: Referentenhonorar St. Jude Medical, Volcano Corp. G. Richardt: Referentenhonorar St. Jude Medical. T. Schmitz: Proctortätigkeit St. Jude Medical. S. Achenbach: Forschungsunterstützung (an die Institution) Siemens Healthcare, Abbott Vascular. T. Rudolph, H. Eggebrecht und N. Werner und geben an, dass kein Interessenkonflikt besteht.

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Möllmann, H., Rudolph, T., Rieber, J. et al. Fraktionelle Flussreserve in der Diagnostik der koronaren Herzerkrankung. Kardiologe 10, 88–105 (2016). https://doi.org/10.1007/s12181-016-0049-5

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