Диагностическая ценность определения фракционного резерва кровотока: внимание, реология крови!

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.

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