cardiotomskСибирский журнал клинической и экспериментальной медициныSiberian Journal of Clinical and Experimental Medicine2713-29272713-265XTSU publishing10.29001/2073-8552-2025-40-4-19-27cardiotomsk-2906Research ArticleОБЗОРЫREVIEWSДиагностическая ценность определения фракционного резерва кровотока: внимание, реология крови!Diagnostic value of the fractional flow reserve: attention, blood rheology!https://orcid.org/0000-0003-0578-5962БессоновИ. С.BessonovI. S.

Бессонов Иван Сергеевич, д-р мед. наук, заведующий лабораторией рентгенэндоваскулярных методов диагностики и лечения, научный отдел инструментальных методов исследования, Тюменский кардиологический научный центр, Томский НИМЦ.

625026, Тюмень, ул. Мельникайте, 111

Ivan S. Bessonov - Dr. Sci. (Med.), Head of the Laboratory of X-ray Endovascular Diagnostic and Treatment Methods, Scientific Department of Instrumental Research Methods, Tyumen Cardiology Research Center, Tomsk NRMC.

111, Melnikaite str., Tyumen, 625026

IvanBessnv@gmail.comhttps://orcid.org/0000-0001-6397-488XСтародумовИ. О.StarodumovI. O.

Стародумов Илья Олегович - канд. физ.-мат. наук, ведущий научный сотрудник, лаборатория моделирования многофазных физико-биологических сред, Уральский федеральный университет.

620002, Екатеринбург, ул. Мира, 19

Ilya O. Starodumov - Cand. Sci. (Phys.-Math.), Senior Research Scientist, Laboratory of Multiphase Physical and Biological Media Modeling, Ural Federal University.

19, Mira Str., Ekaterinburg, 620002

Ilya.Starodumov@urfu.ruhttps://orcid.org/0000-0001-9759-9969ШадринА. А.ShadrinA. A.

Шадрин Артем Алексеевич - младший научный сотрудник, лаборатория рентгенэндоваскулярных методов диагностики и лечения, научный отдел инструментальных методов исследования, аспирант, Тюменский кардиологический научный центр, Томский НИМЦ.

625026, Тюмень, ул. Мельникайте, 111

Artem A. Shadrin - Junior Research Scientist, Laboratory of X-ray Endovascular Diagnostic and Treatment Methods, Scientific Department of Instrumental Research Methods; Postgraduate Student, Tyumen Cardiology Research Center, Tomsk NRMC.

111, Melnikaite str., Tyumen, 625026

shadrin_artem_97@bk.ruhttps://orcid.org/0009-0009-0642-3307МахаеваК. Е.MakhaevaK. E.

Махаева Ксения Евгеньевна - инженер-исследователь, лаборатория моделирования многофазных физико-биологических сред, УрФУ.

620002, Екатеринбург, ул. Мира, 19

Ksenia E. Makhaeva - Research Engineer, Laboratory of Multiphase Physical and Biological Media Modeling, Ural Federal University.

19, Mira Str., Ekaterinburg, 620002

ksenia.makhaeva@urfu.ruhttps://orcid.org/0000-0003-3455-5381МикушинП. В.MikushinP. V.

Микушин Павел Владимирович - младший научный сотрудник, лаборатория моделирования многофазных физико-биологических сред, УрФУ; аспирант, МФТИ.

620002, Екатеринбург, ул. Мира, 19; 141701, Московская область, Долгопрудный, Институтский переулок, 9

Pavel V. Mikushin, Junior Research Scientist, Laboratory of Multiphase Physical and Biological Media Modeling, Ural Federal University, Yekaterinburg, Russia; Postgraduate Student, Moscow Institute of Physics and Technology (MIPT).

19, Mira Str., Ekaterinburg, 620002; 9 Institutskiy per., Dolgoprudny, Moscow Region, 141701

mikushin.pv18@physics.msu.ruhttps://orcid.org/0000-0002-5502-9164МуравьевА. В.MuravyovA. V.

Муравьев Алексей Васильевич - д-р биол. наук, профессор, кафедра медико-биологических основ спорта, ЯГПУ им. К.Д. Ушинского.

150000, Ярославль, ул. Республиканская, 108/1

Alexey V. Muravyov - Dr. Sci. (Biol.), Professor, Department of Medical and Biological Foundations of Sports, Ushinsky Yaroslavl State Pedagogical University.

108/1, Republicanskaya Str., Yaroslavl, 150000

alexei.47@mail.ruhttps://orcid.org/0000-0002-6331-5320ЧестухинВ. В.ChestukhinV. V.

Честухин Василий Васильевич - д-р мед. наук, профессор, научный консультант, отделение рентгенэндоваскулярной диагностики и хирургии, НИИ скорой помощи им. Н.В. Склифосовского ДЗМ.

129090, Москва, пл. Б. Сухаревская, 3

Vasily V. Chestukhin - Dr. Sci. (Med.), Professor, Scientific Consultant, Department of X-ray Endovascular Diagnostics and Surgery, N.V. Sklifosovsky Research Institute for Emergency Medicine.

3, B. Sykharevskaya Sq., Moscow, 129090

vchestukhin@gmail.comhttps://orcid.org/0000-0003-4434-2873БляхманФ. А.BlyakhmanF. A.

Бляхман Феликс Абрамович - д-р биол. наук, профессор, кафедра медицинской физики и цифровых технологий, УГМУ Минздрава России, Екатеринбург; профессор, институт естественных наук и математики, УрФУ.

620002, Екатеринбург, ул. Мира, 19; 620028, Екатеринбург, ул. Репина, 3

Felix A. Blyakhman - Dr. Sci. (Biol.), Professor, Department of Medical Physics and Digital Technologies, Ural State Medical University, Ministry of Health of Russia, Yekaterinburg, Russia; Professor, Institute of Natural Sciences and Mathematics, Ural Federal University.

19, Mira Str., Ekaterinburg, 620002; 3, Repin Str., Ekaterinburg, 620028

Feliks.Blyakhman@urfu.ruТюменский кардиологический научный центр, Томский национальный исследовательский медицинский центр Российской академии наук (Тюменский кардиологический научный центр, Томский НИМЦ)РоссияTyumen Cardiology Research Center, Tomsk National Research Medical Center, Russian Academy of Sciences (Tyumen Cardiology Research Center, Tomsk NRMC)Russian FederationУральский федеральный университет имени первого Президента России Б.Н. Ельцина Министерства образования и науки Российской Федерации (УрФУ)РоссияUral Federal UniversityRussian FederationУральский федеральный университет имени первого Президента России Б.Н. Ельцина Министерства образования и науки Российской Федерации (УрФУ); Московский физико-технический институт (национальный исследовательский университет) (МФТИ)РоссияUral Federal University; Moscow Institute of Physics and TechnologyRussian FederationЯрославский государственный педагогический университет имени К.Д. Ушинского (ЯГПУ им. К.Д. Ушинского)РоссияYaroslavl State Pedagogical University named after K.D. UshinskyRussian FederationНаучно-исследовательский институт скорой помощи имени Н.В. Склифосовского Департамента здравоохранения Москвы (НИИ скорой помощи им. Н.В. Склифосовского ДЗМ)РоссияSklifosovsky Research Institute of Emergency CareRussian FederationУральский федеральный университет имени первого Президента России Б.Н. Ельцина Министерства образования и науки Российской Федерации (УрФУ); Уральский государственный медицинский университет Министерства здравоохранения Российской Федерации (УГМУ Минздрава России)РоссияUral Federal University; Ural State Medical UniversityRussian Federation2025121220254041927Copyright © Бессонов И.С., Стародумов И.О., Шадрин А.А., Махаева К.Е., Микушин П.В., Муравьев А.В., Честухин В.В., Бляхман Ф.А., 20252025Бессонов И.С., Стародумов И.О., Шадрин А.А., Махаева К.Е., Микушин П.В., Муравьев А.В., Честухин В.В., Бляхман Ф.А.Bessonov I.S., Starodumov I.O., Shadrin A.A., Makhaeva K.E., Mikushin P.V., Muravyov A.V., Chestukhin V.V., Blyakhman F.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.sibjcem.ru/jour/article/view/2906

Оценка гемодинамической (функциональной) значимости стеноза коронарных артерий (КА) приобретает ключевую роль в выборе тактики лечения ишемической болезни сердца (ИБС). В связи с этим широкое распространение получили инвазивные методы оценки функциональной значимости стенозов, основанные на катетеризации артерий в ходе ангиографического обследования пациентов. Для этой цели также стали использоваться диагностические технологии, совмещающие возможности коронарной ангиографии и математического моделирования гемодинамики в сосудах. Настоящая работа представляет собой аналитический обзор литературы, посвященный проблеме оценки гемодинамической значимости стенозов КА при ИБС с помощью метода определения фракционного резерва кровотока (ФРК). В материалах представлены сведения о биофизической основе метода определения ФРК, особенностях практического применения и диагностической ценности. При этом существенное внимание уделено реологическим свойствам крови и особенно ее интегральной характеристике – динамической вязкости. Поскольку она является основой гемодинамического сопротивления кровотока, особенно в регионарных сосудах и микроциркуляции, этот фактор может оказывать влияние на интерпретацию результатов оценки значимости коронарных стенозов.

Assessment of hemodynamic significance of coronary artery stenosis has become crucial in determining the treatment strategy for coronary artery disease (CAD). Consequently, invasive methods for evaluating the functional significance of stenosis have become widely used. Additionally, diagnostic technologies that combine coronary angiography and mathematical modeling of coronary flow have also been employed for this purpose.

This paper presents an analytical review of the assessment of the functional significance of coronary artery stenosis using the fractional flow reserve (FFR) method. The review covers the fundamental aspects of the FFR method, its practical application, and its diagnostic value. Significant attention is given to blood rheology, particularly dynamic viscosity. Since dynamic viscosity is a key determinant of hemodynamic resistance to blood flow, especially in microcirculation, this factor can influence the interpretation of the results in coronary stenosis assessment.

ишемическая болезнь сердцастеноз коронарных артерийгемодинамическая значимость стенозафракционный резерв кровотокареология кровиреваскуляризация миокардаcoronary artery diseasecoronary artery stenosishemodynamic significance of stenosisfractional blood flow reserveblood rheologymyocardial revascularizationработа выполнена при финансовой поддержке Российского научного фонда (грант РНФ № 22-71-10071 «Гемореологическое моделирование течений в коронарных артериях для нужд персонифицированной диагностики и лечения ишемической болезни сердца»)this work was supported by the Russian Science Foundation (RSF grant No. 22-71-10071 “Hemorheological modeling of flows in coronary arteries for the needs of personalized diagnosis and treatment of coronary heart disease”)ReferencesTonino P.A., Fearon W.F., De Bruyne B., Oldroyd K.G., Leesar M.A., Ver Lee P.N. et al. 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The authors declare that there are no conflicts of interest present.