Статья
Несмотря на то, что коронарография является общепризнанным «золотым стандартом» диагностики стенозирующих поражений коронарного русла, оценка их гемодинамической значимости в большинстве случаев остается оператор-зависимой. В настоящее время, для объективизации измерений рекомендовано применение методов, позволяющих анализировать показатели внутрикоронарной физиологии. На фоне активного развития технологий искусственного интеллекта (ИИ) появляются новые решения для неинвазивной оценки параметров гемодинамики, ряд из которых уже был валидирован в рамках крупных исследований. Целью обзора является анализ и систематизация опубликованных данных о применяемых методов ИИ в неинвазивной оценке параметров гемодинамики коронарных артерий. При подготовке обзора использованы публикации, индексируемые в базах PubMed, Google Scholar, Web of Science, Cyberleninka и E-Library. Глубина поиска составила 10 лет, начиная с 2016 г. В основу обзора включены обобщенные данные из наиболее актуальных клинических исследований и систематических обзоров. Проведенный анализ литературы позволил сделать заключение о том, что результаты применения технологий ИИ для оценки параметров гемодинамики коронарных артерий сопоставимы с результатами классических инвазивных методик. Тем не менее дальнейшие разработка и совершенствование данного направления остаются актуальной исследовательской задачей.
1. Shi H, Xia Y, Cheng Y, et al. Global burden of ischaemic heart disease from 2022 to 2050: projections of incidence, prevalence, deaths, and disability-adjusted life years. European Heart Journal-Quality of Care and Clinical Outcomes. 2025;11(4):355-366. doi: 10.1093/ehjqcco/qcae049.
2. Barbarash OL, Karpov YuA, Panov AV, et al. 2024 Clinical practice guidelines for Stable coronary artery disease. Russian Journal of Cardiology. 2024;29(9):6110. (In Russ.) Барбараш О.Л., Карпов Ю.А., Панов А.В., и др. Стабильная ишемическая болезнь сердца. Клинические рекомендации 2024. Российский кардиологический журнал. 2024;29(9):6110. doi: 10.15829/1560-4071-2024-6110.
3. Pijls NH, Van Schaardenburgh P, Manoharan G, et al. Percutaneous coronary intervention of functionally nonsignificant stenosis: 5-year follow-up of the DEFER Study. Journal of the American College of Cardiology. 2007;49(21):2105-2111. doi: 10.1016/j.jacc.2007.01.087.
4. Zimmermann FM, Ferrara A, Johnson NP, et al. Deferral vs. performance of percutaneous coronary intervention of functionally non-significant coronary stenosis: 15-year follow-up of the DEFER trial. European heart journal. 2015;36(45):3182-3188. doi: 10.1093/eurheartj/ehv452.
5. Tonino PA, De Bruyne B, Pijls NH, et al. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention. New England Journal of Medicine. 2009;360(3):213-224. doi: 10.1056/NEJMoa0807611.
6. Fearon WF, Nishi T, De Bruyne B, et al. Clinical Outcomes and Cost-Effectiveness of Fractional Flow Reserve-Guided Percutaneous Coronary Intervention in Patients With Stable Coronary Artery Disease: Three-Year Follow-Up of the FAME 2 Trial (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation). Circulation. 2018;137(5):480-487. doi: 10.1161/CIRCULATIONAHA.117.031907.
7. Davies JE, Sen S, Dehbi HM, et al. Use of the Instantaneous Wave-free Ratio or Fractional Flow Reserve in PCI. New England Journal of Medicine. 2017;376(19):1824-1834. doi: 10.1056/NEJMoa1700445.
8. Götberg M, Christiansen EH, Gudmundsdottir IJ, et al. Instantaneous Wave-free Ratio versus Fractional Flow Reserve to Guide PCI. New England Journal of Medicine. 2017;376(19):1813-1823. doi: 10.1056/NEJMoa1616540.
9. Vrints C, Andreotti F, Koskinas KC, et al. 2024 ESC guidelines for the management of chronic coronary syndromes: developed by the task force for the management of chronic coronary syndromes of the European Society of Cardiology (ESC) endorsed by the European Association for Cardio-Thoracic Surgery (EACTS). European heart journal. 2024;45(36):3415-3537. doi: 10.1093/eurheartj/ehae177.
10. Trofimov YuV, Semashko VS, Muravyov IP, et al. Fuzzy production rules and deep learning neural networks: explicable artificial intelligence 2.0 for the diagnosis of coronary stenosis. System analysis in science and education. 2025;2:73-82. (in Russ) Трофимов Ю.В., Семашко В.С., Муравьев И.П. и др. Нечёткие продукционные правила и нейросети глубокого обучения: объяснимый искусственный интеллект 2.0 для диагностики коронарных стенозов. Системный анализ в науке и образовании. 2025;2:73-82. EDN: ONRAKG.
11. Bochkarev VA, Usynin AA, Osipov AD, et al. Models of Cardiac Artery Segmentation Based on Coronary Angiographic Images. Bulletin of Perm University. Mathematics. Mechanics. Computer Science. 2025;2(69):65-87. (In Russ.) Бочкарев В.А., Усынин А.А., Осипов А.Д. и др. Модели сегментации сердечных артерий по коронарографическим снимкам. Вестник Пермского университета. Математика. Механика. Информатика. 2025;2(69):65-87. doi: 10.17072/1993-0550-2025-2-65-87.
12. Abdualimov TP, Obrezan AG. Potential of artificial intelligence in prediction of coronary arterial lesions. Kardiologiya: novosti, mneniya, obuchenie. 2022;10(1-28):34-39. (In Russ.) Абдуалимов Т.П., Обрезан А.Г. Возможности искусственного интеллекта в прогнозировании поражения коронарных артерий. Кардиология: новости, мнения, обучение. 2022;10(1-28):34-39. doi: 10.33029/2309-1908-2022-10-1-34-39.
13. Gognieva DG, Gamilov TM, Pryamonosov RA, et al. Noninvasive assessment of the fractional reserve of coronary blood flow with a one-dimensional mathematical model. Preliminary results of the pilot study. Russian Journal of Cardiology. 2019;24(3):60-68. (In Russ.) Гогниева Д.Г., Гамилов Т.М., Прямоносов Р.А., и др. Неинвазивная оценка фракционного резерва коронарного кровотока при помощи одномерной математической модели. Промежуточные результаты пилотного исследования. Российский кардиологический журнал. 2019;24(3):60-68. doi: 10.15829/1560-4071-2019-3-60-68.
14. Gognieva DG, Pershina ES, Mitina YuO, et al. Non-invasive fractional flow reserve: a comparison of one-dimensional and three-dimensional mathematical modeling effectiveness. Cardiovascular Therapy and Prevention. 2020;19(2):2303. (In Russ.) Гогниева Д.Г., Першина Е.С., Митина Ю.О., и др. Сравнение диагностической эффективности методик неинвазивного расчета фракционного резерва кровотока, основанных на построении одномерной и трехмерной математических моделей. Кардиоваскулярная терапия и профилактика. 2020;19(2):2303. doi: 10.15829/1728-8800-2020-2303.
15. Pijls NH, van Son JA, Kirkeeide RL, et al. Experimental basis of determining maximum coronary, myocardial, and collateral blood flow by pressure measurements for assessing functional stenosis severity before and after percutaneous transluminal coronary angioplasty. Circulation. 1993;87(4):1354-67. doi: 10.1161/01.cir.87.4.1354.
16. Lotfi A, Jeremias A, Fearon WF, et al. Expert consensus statement on the use of fractional flow reserve, intravascular ultrasound, and optical coherence tomography: a consensus statement of the Society of Cardiovascular Angiography and Interventions. Catheter Cardiovasc Interv. 2014;83(4):509-18. doi: 10.1002/ccd.25222.
17. Pijls NH, De Bruyne B, Peels K, et al. Measurement of fractional flow reserve to assess the functional severity of coronary-artery stenoses. New England Journal of Medicine. 1996;334(26):1703-8. doi: 10.1056/NEJM199606273342604.
18. Zhang D, Lv S, Song X, et al. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention: a meta-analysis. Heart. 2015;101(6):455-62. doi: 10.1136/heartjnl-2014-306578.
19. Antoniadis M, Stader J, Ussat M, et al. Comparison of quantitative flow ratio (QFR) and instantaneous wave-free ratio (iFR) or resting full-cycle ratio (RFR) during daily routine in the catheterization laboratory. European Heart Journal. 2022;43(S2):ehac544.1369. doi: 10.1093/eurheartj/ehac544.1369.
20. Salihu A, Zulauff J, Gadiri MA, et al. Head‐to‐Head Comparison of Learning Curves Between QFR and FFRangio Software Users. Catheterization and Cardiovascular Interventions. 2025;105(3):692-697. doi: 10.1002/ccd.31384.
21. Antoniadis M, Blum M, Ussat, M, et al. Standardized angiographic projections allow evaluation of coronary artery side branches with quantitative flow ratio (QFR). IJC Heart & Vasculature. 2024;50:101349. doi: 10.1016/j.ijcha.2024.101349.
22. Tu S, Ding D, Chang Y, et al. Diagnostic accuracy of quantitative flow ratio for assessment of coronary stenosis significance from a single angiographic view: a novel method based on bifurcation fractal law. Catheterization and Cardiovascular Interventions. 2021;97:1040-1047. doi: 10.1002/ccd.29592.
23. Fearon WF, Achenbach S, Engstrom T, et al. Accuracy of fractional flow reserve derived from coronary angiography. Circulation. 2019;139(4):477-484. doi: 10.1161/CIRCULATIONAHA.118.037350.
24. Kornowski R, Lavi I, Pellicano M, et al. Fractional flow reserve derived from routine coronary angiograms. Journal of the American College of Cardiology. 2016;68(20):2235-2237. doi: 10.1016/j.jacc.2016.08.051.
25. Pellicano M, Lavi I, De Bruyne B et al. Validation study of image-based fractional flow reserve during coronary angiography. Circulation: Cardiovascular Interventions. 2017;10(9):e005259. doi: 10.1161/CIRCINTERVENTIONS.116.005259.
26. Li J, Gong Y, Wang W, et al. Accuracy of computational pressure-fluid dynamics applied to coronary angiography to derive fractional flow reserve: FLASH FFR. Cardiovascular research. 2020;116(7):1349-1356. doi: 10.1093/cvr/cvz289.
27. Masdjedi K, Tanaka N, Van Belle E, et al. Vessel fractional flow reserve (vFFR) for the assessment of stenosis severity: the FAST II study. EuroIntervention. 2022;17(18):1498. doi: 10.4244/EIJ-D-21-00471.
28. Scoccia A, Byrne RA, Banning AP, et al. Fractional flow reserve or 3D-quantitative-coronary-angiography based vessel-FFR guided revascularization. Rationale and study design of the prospective randomized fast III trial. American Heart Journal. 2023;260:1-8. doi: 10.1016/j.ahj.2023.02.003.
29. Pisters R, Ilhan M, Veenstra LF, et al. Instantaneous wave-free ratio and fractional flow reserve in clinical practice. Netherlands Heart Journal. 2018;26:385-392. doi: 10.1007/s12471-018-1125-1.
30. Donnelly PM, Kolossváry M, Karády J, et al. Experience with an on-site coronary computed tomography-derived fractional flow reserve algorithm for the assessment of intermediate coronary stenoses. The American Journal of Cardiology. 2018;121(1):9-13. doi: 10.1016/j.amjcard.2017.09.018.
31. Van Hamersvelt RW, Voskuil M, De Jong PA, et al. Diagnostic performance of on-site coronary CT angiography–derived fractional flow reserve based on patient-specific lumped parameter models. Radiology: Cardiothoracic Imaging. 2019;1(4):e190036. doi: 10.1148/ryct.2019190036.
32. Ono M, Serruys PW, Patel MR, et al. A prospective multicenter validation study for a novel angiography-derived physiological assessment software: Rationale and design of the radiographic imaging validation and evaluation for Angio-iFR (ReVEAL iFR) study. American Heart Journal. 2021;239:19-26. doi: 10.1016/j.ahj.2021.05.004.
33. Li B, Chen H, Wang H, et al. An overview of computational coronary physiology technologies based on medical imaging and artificial intelligence. Reviews in Cardiovascular Medicine. 2024;25(6):211. doi: 10.31083/j.rcm2506211.
34. Oliveira C, Vilela M, Silva Marques J, et al. Non-invasive derivation of instantaneous free-wave ratio from invasive coronary angiography using a new deep learning artificial intelligence model and comparison with human operators’ performance. The International Journal of Cardiovascular Imaging. 2025;41(4):755-771. doi: 10.1007/s10554-025-03369-y.
35. De Filippo O, Mineo R, Millesimo M, et al. Non-invasive physiological assessment of intermediate coronary stenoses from plain angiography through artificial intelligence: the STARFLOW system. European Heart Journal-Quality of Care and Clinical Outcomes. 2025;11(3):343-352. doi: 10.1093/ehjqcco/qcae024.
36. Vira A, Balanescu DV, George JA, et al. Diagnostic Performance of Diastolic Hyperemia-Free Ratio Compared With Invasive Fractional Flow Reserve for Evaluation of Coronary Artery Disease. The American Journal of Cardiology. 2024;214:55-58. doi: 10.1016/j.amjcard.2023.12.050.
37. Roh JW, Lee OH, Kim Y, et al. Diastolic hyperemia-free ratio in patients with coronary artery disease: a prospective observational study. Korean Circulation Journal. – 2025. 55(7):600-610. doi: 10.4070/kcj.2024.0351.
38. Nohara H, Egami Y, Abe M, et al. Diastolic hyperemia-free ratio for the assessment of intermediate coronary artery stenosis in patients with hemodialysis. European Heart Journal. 2024;45(S1):ehae666-1392. doi: 10.1093/eurheartj/ehae666.1392.
39. Tebaldi M, Biscaglia S, Erriquez A, et al. Comparison of quantitative flow ratio, Pd/Pa and diastolic hyperemia-free ratio versus fractional flow reserve in non-culprit lesion of patients with non ST-segment elevation myocardial infarction. Catheterization and Cardiovascular Interventions. 2021;98(6):1057-1065. doi: 10.1002/ccd.29380.
40. Ramamurthy MT, Balakrishnan VK, Vallivedu MV, et al. Improved Diagnosis through Diastolic Hyperemia-Free Ratio (DFR) over Fractional Flow Reserve (FFR) in Intermediate Coronary Lesions. Cardiology and cardiovascular medicine. 2023;7(2):108-116. PMID: 37554658.
41. Svanerud J, Ahn JM, Jeremias A, et al.Validation of a novel non-hyperaemic index of coronary artery stenosis severity: the Resting Full-cycle Ratio (VALIDATE RFR) study. EuroIntervention. 2018;14(7):806-814. doi: 10.4244/EIJ-D-18-00342.
42. Zdzierak B, Zasada W, Krawczyk-Ożóg A, et al. Comparison of Fractional Flow Reserve with Resting Non-Hyperemic Indices in Patients with Coronary Artery Disease. Journal of Cardiovascular Development and Disease. 2023;10(2):34. doi: 10.3390/jcdd10020034.
43. Wienemann H, Meyer A, Mauri V, et al. Comparison of Resting Full-Cycle Ratio and Fractional Flow Reserve in a German Real-World Cohort. Frontiers in cardiovascular medicine. 2021;8:744181. doi: 10.3389/fcvm.2021.744181.
44. Kato Y, Dohi T, Chikata Y, et al. Predictors of discordance between fractional flow reserve and resting full-cycle ratio in patients with coronary artery disease: Evidence from clinical practice. Journal of Cardiology. 2021;77(3):313-319. doi: 10.1016/j.jjcc.2020.10.014.
45. Lee JM, Choi KH, Park J, et al. Physiological and clinical assessment of resting physiological indexes: resting full-cycle ratio, diastolic pressure ratio, and instantaneous wave-free ratio. Circulation. 2019;139(7):889-900. doi: 10.1161/CIRCULATIONAHA.118.037021.
46. Lee OH, Roh JW, Kim Y, et al. Invasive physiologic assessment of coronary artery stenosis by resting full-cycle ratio and fractional flow reserve: a prospective observational study. Scientific Reports. 2023;13(1):15783. doi: 10.1038/s41598-023-43082-1.