循環器ジャーナル67巻1号

2019年01月発行

特集 循環器の現場からの検証：そのエビデンスを日本で活用するには？ Ⅲ．虚血性心疾患

これからの狭心症の診断はシンチからFFRCTに置き換わっていくのか—PLATFORMやRIPCORD試験の結果を踏まえて

著者： 中里良¹

所属機関： ¹聖路加国際病院心血管センター

ページ範囲：P.68 - P.72

Point
・FFRCTは解剖学的および機能的データ両方が得られる非侵襲的検査である．
・侵襲的冠動脈造影（ICA）前にFFRCTを用いて虚血評価を行うことで不要なICAを減少させることができる．
・国内で保険収載されれば日常臨床での安定狭心症診断のアプローチが大きく変わる可能性がある．

参考文献

1) Taylor CA, Fonte TA, Min JK:Computational fluid dynamics applied to cardiac computed tomography for noninvasive quantification of fractional flow reserve:scientific basis. J Am Coll Cardiol 61:2233-2241, 2013

2) Nørgaard BL, Leipsic J, Gaur S, et al:Diagnostic performance of noninvasive fractional flow reserve derived from coronary computed tomography angiography in suspected coronary artery disease:the NXT trial（Analysis of Coronary Blood Flow Using CT Angiography:Next Steps）. J Am Coll Cardiol 63:1145-1155, 2014

3) Koo BK, Erglis A, Doh JH, et al:Diagnosis of ischemia-causing coronary stenoses by noninvasive fractional flow reserve computed from coronary computed tomographic angiograms. Results from the prospective multicenter DISCOVER-FLOW（Diagnosis of Ischemia-Causing Stenoses Obtained Via Noninvasive Fractional Flow Reserve）study. J Am Coll Cardiol 58:1989-1997, 2011

4) Min JK, Leipsic J, Pencina MJ, et al:Diagnostic accuracy of fractional flow reserve from anatomic CT angiography. JAMA 308:1237-1245, 2012

5) Douglas PS, Pontone G, Hlatky MA, et al:Clinical outcomes of fractional flow reserve by computed tomographic angiography-guided diagnostic strategies vs. usual care in patients with suspected coronary artery disease:the prospective longitudinal trial of FFR（CT）:outcome and resource impacts study. Eur Heart J 36:3359-3367, 2015

6) Hlatky MA, De Bruyne B, Pontone G, et al:Quality-of-Life and Economic Outcomes of Assessing Fractional Flow Reserve With Computed Tomography Angiography:PLATFORM. J Am Coll Cardiol 66:2315-2323, 2015

7) Douglas PS, De Bruyne B, Pontone G, et al:1-Year Outcomes of FFRCT-Guided Care in Patients With Suspected Coronary Disease:The PLATFORM Study. J Am Coll Cardiol 68:435-445, 2016

8) Curzen NP, Nolan J, Zaman AG, et al:Does the Routine Availability of CT-Derived FFR Influence Management of Patients With Stable Chest Pain Compared to CT Angiography Alone?:The FFRCT RIPCORD Study. JACC Cardiovasc Imaging 9:1188-1194, 2016

9) Chinnaiyan KM, Akasaka T, Amano T, et al:Rationale, design and goals of the HeartFlow assessing diagnostic value of non-invasive FFRCT in Coronary Care（ADVANCE）registry. J Cardiovasc Comput Tomogr 11:62-67, 2017

10) Rizvi A, Hartaigh BO, Knaapen P, et al:Rationale and Design of the CREDENCE Trial:computed TomogRaphic evaluation of atherosclerotic DEtermiNants of myocardial IsChEmia. BMC Cardiovasc Disord 16:190, 2016

11) Nakazato R, Park HB, Berman DS, et al:Noninvasive Fractional Flow Reserve Derived From Computed Tomography Angiography for Coronary Lesions of Intermediate Stenosis Severity:Results From the DeFACTO Study. Circ Cardiovasc Imaging 6:881-889, 2013

12) Abbara S, Arbab-Zadeh A, Callister TQ, et al:SCCT guidelines for performance of coronary computed tomographic angiography:a report of the Society of Cardiovascular Computed Tomography Guidelines Committee. J Cardiovasc Comput Tomogr 3:190-204, 2009