1
|
Shin D, Lee SH, Hong D, Choi KH, Lee JM. Physiologic Assessment After Percutaneous Coronary Interventions and Functionally Optimized Revascularization. Cardiol Clin 2024; 42:55-76. [PMID: 37949540 DOI: 10.1016/j.ccl.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
Coronary physiologic assessment has become a standard of care for patients with coronary atherosclerotic disease. While most attention has focused on pre-interventional physiologic assessment to aid in revascularization decision-making, post-interventional physiologic assessment has not been as widely used, despite evidence supporting its role in assessment and optimization of the revascularization procedure. A thorough understanding of such evidence and ongoing studies would be crucial to incorporate post-interventional physiologic assessment into daily practice. Thus, this review provides a comprehensive overview of current evidence regarding the evolving role of physiologic assessment as a functional optimization tool for the entire revascularization process.
Collapse
Affiliation(s)
- Doosup Shin
- Division of Cardiology, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27710, USA
| | - Seung Hun Lee
- Department of Internal Medicine and Cardiovascular Center, Chonnam National University Hospital, 42, Jebong-ro, Dong-gu, Gwangju 61469, Republic of Korea
| | - David Hong
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea
| | - Ki Hong Choi
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea
| | - Joo Myung Lee
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea.
| |
Collapse
|
2
|
Nijjer SS. Using Physiology Pullback for Percutaneous Coronary Intervention Guidance: Is this the Future? Cardiol Clin 2024; 42:41-53. [PMID: 37949539 DOI: 10.1016/j.ccl.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
Modern coronary intervention requires integration of angiographic, physiologic, and intravascular imaging. This article describes the use and techniques needed to understand coronary physiology pullback data and how use it to make revascularization decisions. The article describes instantaneous wave-free ratio, fractional flow reserve, and the data that support their use and how they differ when used in tandem disease. Common practical mistakes and errors are discussed together with a brief review of the limited published research data.
Collapse
Affiliation(s)
- Sukhjinder Singh Nijjer
- Department of Cardiology, Imperial College London, Hammersmith Hospital, Du Cane Road, London, W12 0HS, United Kingdom. https://twitter.com/SukhNijjer
| |
Collapse
|
3
|
Koo BK, Hwang D, Park S, Kuramitsu S, Yonetsu T, Kim CH, Zhang J, Yang S, Doh JH, Jeong YH, Choi KH, Lee JM, Ahn JM, Matsuo H, Shin ES, Hu X, Low AF, Kubo T, Nam CW, Yong AS, Harding SA, Xu B, Hur SH, Choo GH, Tan HC, Mullasari A, Hsieh IC, Kakuta T, Akasaka T, Wang J, Tahk SJ, Fearon WF, Escaned J, Park SJ. Practical Application of Coronary Physiologic Assessment: Asia-Pacific Expert Consensus Document: Part 2. JACC. ASIA 2023; 3:825-842. [PMID: 38155788 PMCID: PMC10751650 DOI: 10.1016/j.jacasi.2023.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 07/08/2023] [Indexed: 12/30/2023]
Abstract
Coronary physiologic assessment is performed to measure coronary pressure, flow, and resistance or their surrogates to enable the selection of appropriate management strategy and its optimization for patients with coronary artery disease. The value of physiologic assessment is supported by a large body of clinical data that has led to major recommendations in all practice guidelines. This expert consensus document aims to convey practical and balanced recommendations and future perspectives for coronary physiologic assessment for physicians and patients in the Asia-Pacific region, based on updated information in the field that includes both wire- and image-based physiologic assessment. This is Part 2 of the whole consensus document, which provides theoretical and practical information on physiologic indexes for specific clinical conditions and patient statuses.
Collapse
Affiliation(s)
- Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Doyeon Hwang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Sungjoon Park
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Shoichi Kuramitsu
- Department of Cardiovascular Medicine, Sapporo Heart Center, Sapporo Cardio Vascular Clinic, Sapporo, Japan
| | - Taishi Yonetsu
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Chee Hae Kim
- Department of Internal Medicine and Cardiovascular Center, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Jinlong Zhang
- Department of Cardiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Seokhun Yang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Joon-Hyung Doh
- Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Young-Hoon Jeong
- CAU Thrombosis and Biomarker Center, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Korea and Department of Internal Medicine, Chung-Ang University School of Medicine, Seoul, Korea
| | - Ki Hong Choi
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joo Myung Lee
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung-Min Ahn
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hitoshi Matsuo
- Department of Cardiovascular Medicine, Gifu Heart Center, Japan
| | - Eun-Seok Shin
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Xinyang Hu
- Department of Cardiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Adrian F. Low
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; National University Heart Centre, National University Health System, Singapore
| | - Takashi Kubo
- Department of Cardiology, Tokyo Medical University, Hachioji Medical Center, Tokyo, Japan
| | - Chang-Wook Nam
- Department of Internal Medicine and Cardiovascular Research Institute, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Andy S.C. Yong
- Department of Cardiology, Concord Hospital, University of Sydney, Sydney, Australia
| | - Scott A. Harding
- Department of Cardiology, Wellington Hospital, Wellington, New Zealand
| | - Bo Xu
- Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Seung-Ho Hur
- Department of Internal Medicine and Cardiovascular Research Institute, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Gim Hooi Choo
- Department of Cardiology, Cardiac Vascular Sentral KL (CVSKL), Kuala Lumpur, Malaysia
| | - Huay Cheem Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; National University Heart Centre, National University Health System, Singapore
| | - Ajit Mullasari
- Department of Cardiology, Madras Medical Mission, Chennai, India
| | - I-Chang Hsieh
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Tsunekazu Kakuta
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Jian'an Wang
- Department of Cardiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Seung-Jea Tahk
- Department of Cardiology, Ajou University Medical Center, Suwon, Korea
| | - William F. Fearon
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Javier Escaned
- Hospital Clinico San Carlos IDISSC, Complutense University of Madrid, Madrid, Spain
| | - Seung-Jung Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
4
|
Khan SA, Alsanjari O, Keulards DCJ, Vlaar PJ, Zhang J, Konstantinou K, Fawaz S, Simpson R, Clesham G, Kelly PA, Tang KH, Cook CM, Cockburn J, Pijls NHJ, Hildick-Smith D, Teeuwen K, Keeble TR, Karamasis GV, Davies JR. Changes in absolute flow, myocardial resistance and FFR after chronic total occlusion percutaneous coronary intervention. EUROINTERVENTION 2023; 19:e123-e133. [PMID: 36722201 PMCID: PMC10242660 DOI: 10.4244/eij-d-22-00694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 12/07/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Randomised studies of percutaneous coronary intervention (PCI) in patients with chronic total occlusion (CTO) have shown inconsistent outcomes, suggesting incomplete understanding of this cohort and their coronary physiology. To address this shortcoming, we designed a prospective observational study to measure the recovery of absolute coronary blood flow following successful CTO PCI Aims: We sought to identify patient and procedural characteristics associated with a favourable physiological outcome after CTO PCI. METHODS Consecutive patients with a CTO subtending viable myocardium underwent PCI utilising contemporary techniques and the hybrid algorithm. Immediately after PCI, and at 3-month follow-up, physiological measurements were performed utilising continuous thermodilution. RESULTS A total of 81 patients were included with a mean age of 63.6±8.9 years, and 66 (81.5%) were male. Physiological measurements of absolute coronary blood flow in the CTO vessel increased by 30% (p<0.001) and microvascular resistance reduced by 16% (p<0.001) from immediately post-CTO PCI to follow-up assessment. Fractional flow reserve increased by 0.02 (p=0.015) in the same period. Prior coronary artery bypass graft (CABG) and a higher estimated glomerular filtration rate (eGFR) were associated with a larger change in absolute flow. An extraplaque strategy was associated with a smaller change in absolute flow. CONCLUSIONS Post-CTO PCI, there is a continued augmentation in absolute coronary blood flow and reduction in microvascular resistance from baseline to follow-up at 3 months. Prior CABG and a higher baseline eGFR were predictors of a larger change in absolute coronary flow, whilst an extraplaque final wire path strategy predicted a smaller change. Lastly, the patient characteristics and comorbidities had a larger influence than procedural factors on the observed change in absolute flow.
Collapse
Affiliation(s)
- Sarosh A Khan
- Essex Cardiothoracic Centre, Basildon University Hospital, Basildon, UK
- Anglia Ruskin University, Chelmsford, UK
| | - Osama Alsanjari
- Essex Cardiothoracic Centre, Basildon University Hospital, Basildon, UK
- Anglia Ruskin University, Chelmsford, UK
| | | | | | | | - Klio Konstantinou
- Essex Cardiothoracic Centre, Basildon University Hospital, Basildon, UK
- Anglia Ruskin University, Chelmsford, UK
| | - Samer Fawaz
- Essex Cardiothoracic Centre, Basildon University Hospital, Basildon, UK
- Anglia Ruskin University, Chelmsford, UK
| | - Rupert Simpson
- Essex Cardiothoracic Centre, Basildon University Hospital, Basildon, UK
- Anglia Ruskin University, Chelmsford, UK
| | - Gerald Clesham
- Essex Cardiothoracic Centre, Basildon University Hospital, Basildon, UK
- Anglia Ruskin University, Chelmsford, UK
| | | | | | - Christopher M Cook
- Essex Cardiothoracic Centre, Basildon University Hospital, Basildon, UK
- Anglia Ruskin University, Chelmsford, UK
| | | | | | | | | | - Thomas R Keeble
- Essex Cardiothoracic Centre, Basildon University Hospital, Basildon, UK
- Anglia Ruskin University, Chelmsford, UK
| | - Grigoris V Karamasis
- Essex Cardiothoracic Centre, Basildon University Hospital, Basildon, UK
- Anglia Ruskin University, Chelmsford, UK
- Attikon University Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - John R Davies
- Essex Cardiothoracic Centre, Basildon University Hospital, Basildon, UK
- Anglia Ruskin University, Chelmsford, UK
| |
Collapse
|
5
|
Shin D, Lee SH, Hong D, Choi KH, Lee JM. Physiologic Assessment After Percutaneous Coronary Interventions and Functionally Optimized Revascularization. Interv Cardiol Clin 2023; 12:55-69. [PMID: 36372462 DOI: 10.1016/j.iccl.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Coronary physiologic assessment has become a standard of care for patients with coronary atherosclerotic disease. While most attention has focused on pre-interventional physiologic assessment to aid in revascularization decision-making, post-interventional physiologic assessment has not been as widely used, despite evidence supporting its role in assessment and optimization of the revascularization procedure. A thorough understanding of such evidence and ongoing studies would be crucial to incorporate post-interventional physiologic assessment into daily practice. Thus, this review provides a comprehensive overview of current evidence regarding the evolving role of physiologic assessment as a functional optimization tool for the entire revascularization process.
Collapse
Affiliation(s)
- Doosup Shin
- Division of Cardiology, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27710, USA
| | - Seung Hun Lee
- Department of Internal Medicine and Cardiovascular Center, Chonnam National University Hospital, 42, Jebong-ro, Dong-gu, Gwangju 61469, Republic of Korea
| | - David Hong
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea
| | - Ki Hong Choi
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea
| | - Joo Myung Lee
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea.
| |
Collapse
|
6
|
Nijjer SS. Using Physiology Pullback for Percutaneous Coronary Intervention Guidance: Is this the Future? Interv Cardiol Clin 2023; 12:41-53. [PMID: 36372461 DOI: 10.1016/j.iccl.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Modern coronary intervention requires integration of angiographic, physiologic, and intravascular imaging. This article describes the use and techniques needed to understand coronary physiology pullback data and how use it to make revascularization decisions. The article describes instantaneous wave-free ratio, fractional flow reserve, and the data that support their use and how they differ when used in tandem disease. Common practical mistakes and errors are discussed together with a brief review of the limited published research data.
Collapse
Affiliation(s)
- Sukhjinder Singh Nijjer
- Department of Cardiology, Imperial College London, Hammersmith Hospital, Du Cane Road, London, W12 0HS, United Kingdom. https://twitter.com/SukhNijjer
| |
Collapse
|
7
|
D'Antonio A, Assante R, Zampella E, Acampa W. High technology by CZT cameras: It is time to join forces. J Nucl Cardiol 2022; 29:2322-2324. [PMID: 34426936 DOI: 10.1007/s12350-021-02777-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 08/05/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Adriana D'Antonio
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Roberta Assante
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Emilia Zampella
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Wanda Acampa
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy.
| |
Collapse
|
8
|
Liu FS, Wang SY, Shiau YC, Wu YW. Integration of quantitative absolute myocardial blood flow estimates from dynamic CZT-SPECT improves the detection of coronary artery disease. J Nucl Cardiol 2022; 29:2311-2321. [PMID: 34240342 DOI: 10.1007/s12350-021-02713-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 06/17/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Balanced ischemia with multi-vessel coronary artery disease (CAD) is difficult to diagnose with semiquantitative single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI). Dynamic cardiac SPECT provides quantitative estimations of stenosis severity and ischemic burden by assessing myocardial flow reserve (MFR) and myocardial blood flow (MBF). The aim of this study was to evaluate the incremental value of dynamic SPECT in multi-vessel coronary artery disease (CAD). METHODS Patients with suspected CAD who underwent dynamic ECG-gated dipyridamole MPI and coronary angiography within 6 months were retrospectively reviewed. The performance of summed stress, rest and difference scores (SSS, SRS, SDS), post-stress and resting MBF (MBFs, MBFr) and MFR were compared at both patient level and vessel level. RESULTS In 32 patients with 39 stenotic vessels, 12 had three-vessel disease (38%). Globally increased SSS and impaired MBF values were significantly associated with significant CAD at the patient level, but SDS and MFR were not. Regional increases in SSS and reductions in both MBFs and MBFr were significantly associated with stenotic vessels. The best cutoff value of global MBFs to predict CAD was 3.5 ml·g-1·min-1 (area under the curve, AUC = .84, P = .002). The best cutoff value of regional MBFs to detect significant stenosis was 3.6 ml·g-1·min-1 (AUC = .74, P < .001). However, the best possible cut-off values of MFR were not found. Sex-difference in both global and regional MBFr but MBFs was found, which might result in the non-significance in MFR. CONCLUSIONS This study validated a clinically available method to quantify MFR using dynamic CZT-SPECT. This method improved the detectability of multi-vessel CAD, and absolute MBFs was superior to MFR and other semiquantitative MPI parameters.
Collapse
Affiliation(s)
- Fang-Shin Liu
- Department of Nuclear Medicine, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., Banciao Dist., New Taipei City, 220, Taiwan
- Department of Nuclear Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi County, Taiwan
| | - Shan-Ying Wang
- Department of Nuclear Medicine, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., Banciao Dist., New Taipei City, 220, Taiwan
- Department of Nuclear Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei City, Taiwan
| | - Yu-Chien Shiau
- Department of Nuclear Medicine, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., Banciao Dist., New Taipei City, 220, Taiwan
| | - Yen-Wen Wu
- Department of Nuclear Medicine, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., Banciao Dist., New Taipei City, 220, Taiwan.
- Division of Cardiology, Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
- National Yang-Ming University School of Medicine, Taipei City, Taiwan.
- Department of Nuclear Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei City, Taiwan.
| |
Collapse
|
9
|
Guan S, Gan Q, Han W, Zhai X, Wang M, Chen Y, Zhang L, Li T, Chang X, Liu H, Hong W, Li Z, Tu S, Qu X. Feasibility of Quantitative Flow Ratio Virtual Stenting for Guidance of Serial Coronary Lesions Intervention. J Am Heart Assoc 2022; 11:e025663. [PMID: 36129050 PMCID: PMC9673740 DOI: 10.1161/jaha.122.025663] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background Coronary physiology measurement in serial coronary lesions with multiple stenoses is challenging. Therefore, we evaluated the feasibility of Murray fractal law‐based quantitative flow ratio (μQFR) virtual stenting for guidance of serial coronary lesions intervention. Methods and Results Patients who underwent elective coronary angiography and had 2 serial de novo coronary lesions of 30% to 90% diameter stenosis by visual estimation were prospectively enrolled. μQFR and fractional flow reserve (FFR) were assessed after coronary angiography. In vessels with an FFR ≤0.80, the lesion with the larger pressure gradient was considered to be the primary lesion and treated firstly, followed by FFR measurement. The second lesion was stented when FFR ≤0.80. All μQFR and predicted μQFR after stenting were calculated from diagnostic coronary angiography before interventions, with the analysts masked to the FFR data. A total of 54 patients with 61 target vessels were interrogated. Percutaneous coronary intervention was performed in 44 vessels with FFR ≤0.80. After stenting the primary lesions, 14 nonprimary lesions had FFR ≤0.80 and a second drug‐eluting stent was implanted. There was excellent correlation (r=0.97, P<0.001) and good agreement (mean difference: 0.00±0.03) between baseline μQFR and FFR in identifying flow‐limiting lesions. Per‐vessel diagnostic accuracy of μQFR on de novo lesions was 96.7% (95% CI, 88.7%–99.6%). μQFR and FFR are highly consistent (93.2%) in identifying the primary lesion requiring revascularization. After stenting the primary lesions, per‐vessel diagnostic accuracy of predicted μQFR for identifying the significance of the nonprimary lesion was 90.9%. Predicted residual μQFR with virtual stenting was higher than final FFR (mean difference: 0.05±0.06). Conclusions In vessels with serial coronary lesions, virtual stenting by μQFR can identify the primary flow‐limiting lesion for revascularization.
Collapse
Affiliation(s)
- Shaofeng Guan
- Department of Cardiology Huadong Hospital Affiliated to Fudan University Shanghai China.,Shanghai Key Laboratory of Clinical Geriatric Medicine Shanghai China
| | - Qian Gan
- Department of Cardiology Huadong Hospital Affiliated to Fudan University Shanghai China.,Shanghai Key Laboratory of Clinical Geriatric Medicine Shanghai China
| | - Wenzheng Han
- Department of Cardiology Huadong Hospital Affiliated to Fudan University Shanghai China.,Shanghai Key Laboratory of Clinical Geriatric Medicine Shanghai China
| | - Xinrong Zhai
- Department of Cardiology Huadong Hospital Affiliated to Fudan University Shanghai China.,Shanghai Key Laboratory of Clinical Geriatric Medicine Shanghai China
| | - Ming Wang
- Department of Cardiology Huadong Hospital Affiliated to Fudan University Shanghai China.,Shanghai Key Laboratory of Clinical Geriatric Medicine Shanghai China
| | - Yang Chen
- Department of Cardiology Huadong Hospital Affiliated to Fudan University Shanghai China.,Shanghai Key Laboratory of Clinical Geriatric Medicine Shanghai China
| | - Liang Zhang
- Department of Cardiology Huadong Hospital Affiliated to Fudan University Shanghai China.,Shanghai Key Laboratory of Clinical Geriatric Medicine Shanghai China
| | - Tianqi Li
- Department of Cardiology Huadong Hospital Affiliated to Fudan University Shanghai China.,Shanghai Key Laboratory of Clinical Geriatric Medicine Shanghai China
| | - Xifeng Chang
- Department of Cardiology Huadong Hospital Affiliated to Fudan University Shanghai China.,Shanghai Key Laboratory of Clinical Geriatric Medicine Shanghai China
| | - Hongyuan Liu
- Department of Cardiology Huadong Hospital Affiliated to Fudan University Shanghai China.,Shanghai Key Laboratory of Clinical Geriatric Medicine Shanghai China
| | - Weilin Hong
- Department of Cardiology Huadong Hospital Affiliated to Fudan University Shanghai China.,Shanghai Key Laboratory of Clinical Geriatric Medicine Shanghai China
| | - Zehang Li
- Shanghai Jiao Tong University-Pulse Medical Imaging Joint Laboratory Shanghai China
| | - Shengxian Tu
- Biomedical Instrument Institute, School of Biomedical Engineering Shanghai Jiao Tong University Shanghai China
| | - Xinkai Qu
- Department of Cardiology Huadong Hospital Affiliated to Fudan University Shanghai China.,Shanghai Key Laboratory of Clinical Geriatric Medicine Shanghai China
| |
Collapse
|
10
|
Buch AN, Alwair H, Cook CM, Petraco R, Efird JT, Gregory CP, Chagarlamudi AK, Davies JE, van de Hoef TP, Ferguson TB. Immediate impact of coronary artery bypass graft surgery on regional myocardial perfusion: Results from the Collaborative Pilot Study to Determine the Correlation Between Intraoperative Observations Using Spy Near-Infrared Imaging and Cardiac Catheterization Laboratory Physiological Assessment of Lesion Severity. JTCVS OPEN 2022; 12:158-176. [PMID: 36590739 PMCID: PMC9801277 DOI: 10.1016/j.xjon.2022.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/19/2022] [Indexed: 01/04/2023]
Abstract
Objectives Coronary artery bypass grafting (CABG) is performed using anatomic guidance. Data connecting the physiologic significance of the coronary vessel stenosis to the acute physiologic response to grafting are lacking. The Collaborative Pilot Study to Determine the Correlation Between Intraoperative Observations Using Spy Near-Infrared Imaging and Cardiac Catheterization Laboratory Physiological Assessment of Lesion Severity study is the first to compare preintervention coronary physiology with the acute regional myocardial perfusion change (RMP-QC) at CABG in a per-graft analysis. Methods Non-emergent patients undergoing diagnostic catheterization suitable for multivessel CABG were enrolled. Synergy between Percutaneous Coronary Intervention with Taxus score, fractional flow reserve (FFR), instantaneous wave free ratio (iFR), and quantitative coronary angiography was documented in 75 epicardial coronary arteries, with 62 angiographically intermediate and 13 severe stenoses. At CABG, near-infrared fluorescence analysis quantified the relative change (post- vs pregrafting, termed RMP-QC) in the grafted vessel's perfusion territory. Scatter plots were constructed for RMP-QC versus quantitative coronary angiography and RMP-QC versus FFR/iFR. Exact quadrant randomization test for randomness was used. Results There was no relationship between RMP-QC and quantitative coronary angiography percent diameter stenosis, whether all study vessels were included (P = .949) or vessels with core-lab quantitative coronary angiography only (P = .922). A significant nonrandom association between RMP-QC and FFR (P = .025), as well as between RMP-QC and iFR (P = .008), was documented. These associations remained when excluding vessels with assigned FFR and iFR values (P = .0092 and P = .0006 for FFR and iFR, respectively). Conclusions The Collaborative Pilot Study to Determine the Correlation Between Intraoperative Observations Using Spy Near-Infrared Imaging and Cardiac Catheterization Laboratory Physiological Assessment of Lesion Severity study demonstrates there is no association between angiographic coronary stenosis severity and the acute perfusion change after grafting; there is an association between functional stenosis severity and absolute increase in regional myocardial perfusion after CABG.
Collapse
Key Words
- CABG, coronary artery bypass grafting
- FFR, fractional flow reserve
- HSR, hyperemic stenosis resistance index
- NIRF, near-infrared fluorescence angiography
- PCI, percutaneous coronary intervention
- PERSEUS, Collaborative Pilot Study to Determine the Correlation Between Intraoperative Observations Using Spy Near-Infrared Imaging and Cardiac Catheterization Laboratory Physiological Assessment of Lesion Severity
- QCA, quantitative coronary angiography
- RMP-QC, quantified change in regional myocardial perfusion
- SYNTAX, Synergy between Percutaneous Coronary Intervention with Taxus
- bypass grafting
- coronary physiology
- iFR, instantaneous wave free ratio
- myocardial perfusion
Collapse
Affiliation(s)
- Ashesh N. Buch
- Department of Medicine, Chesapeake Regional Medical Center, Chesapeake, Va,Address for reprints: Ashesh N. Buch, MBChB, MD, Chesapeake Regional Medical Center, 736 N Battlefield Blvd, Chesapeake, VA 23320.
| | - Hazaim Alwair
- Department of Cardiothoracic Surgery, Charleston Area Medical Center, Charleston, WVa
| | - Christopher M. Cook
- The Essex Cardiothoracic Center, and Anglia Ruskin University, Cambridge, United Kingdom
| | - Ricardo Petraco
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Jimmy T. Efird
- Veterans Administration Cooperative Studies Program Coordinating Center, Boston VA Health System, Boston, Mass,Department of Radiation Oncology, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | | | - Arjun K. Chagarlamudi
- Division of Cardiology, Department of Medicine, Oregon Health Sciences University, Portland, Ore
| | | | - Tim P. van de Hoef
- Department of Clinical and Experimental Cardiology, Amsterdam UMC-University of Amsterdam, Amsterdam, The Netherlands
| | - T. Bruce Ferguson
- Department of Engineering, East Carolina University, Greenville, NC,Department of Physics, East Carolina University, Greenville, NC,Department of Surgery, East Carolina University, Greenville, NC
| |
Collapse
|
11
|
Ahn JM, Nakayoshi T, Hashikata T, Kashiyama K, Arashi H, Kweon J, Van't Veer M, Lyons J, Fearon WF. Impact of Serial Coronary Stenoses on Various Coronary Physiologic Indices. Circ Cardiovasc Interv 2022; 15:e012134. [PMID: 36126133 DOI: 10.1161/circinterventions.122.012134] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Determining the functional significance of each individual coronary lesion in patients with serial coronary stenoses is challenging. It has been proposed that nonhyperemic pressure ratios, such as the instantaneous wave free ratio (iFR) and the ratio of resting distal to proximal coronary pressure (Pd/Pa) are more accurate than fractional flow reserve (FFR) because autoregulation should maintain stable resting coronary flow and avoid hemodynamic interdependence (cross-talk) that occurs during hyperemia. This study aimed to measure the degree of hemodynamic interdependence of iFR, resting Pd/Pa, and FFR in a porcine model of serial coronary stenosis. METHODS In 6 anesthetized female swine, 381 serial coronary stenoses were created in the left anterior descending artery using 2 balloon catheters. The degree of hemodynamic interdependence was calculated by measuring the absolute changes in iFR, resting Pd/Pa, and FFR across the fixed stenosis as the severity of the other stenosis varied. RESULTS The hemodynamic interdependence of iFR, resting Pd/Pa, and FFR was 0.039±0.048, 0.021±0.026, and 0.034±0.034, respectively (all P<0.001). When the functional significance of serial stenoses was less severe (0.70-0.90 for each index), the hemodynamic interdependence was 0.009±0.020, 0.007±0.013, and 0.017±0.022 for iFR, resting Pd/Pa, and FFR, respectively (all P<0.001). However, in more severe serial coronary stenoses (<0.60 for each index), hemodynamic interdependence was 0.060±0.050, 0.037±0.030, and 0.051±0.037 for iFR, resting Pd/Pa, and FFR, respectively (all P<0.001). CONCLUSIONS When assessing serial coronary stenoses, nonhyperemic pressure ratios are affected by hemodynamic interdependence. When the functional significance of serial coronary stenoses is severe, the effect is similar to that which is seen with FFR.
Collapse
Affiliation(s)
- Jung-Min Ahn
- Division of Cardiovascular Medicine and the Stanford Cardiovascular Institute, Stanford University School of Medicine (J.-M.A., T.N., T.H., K.K., H.A., J.L., W.F.F.).,Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (J.-M.A., J.K.)
| | - Takaharu Nakayoshi
- Division of Cardiovascular Medicine and the Stanford Cardiovascular Institute, Stanford University School of Medicine (J.-M.A., T.N., T.H., K.K., H.A., J.L., W.F.F.)
| | - Takehiro Hashikata
- Division of Cardiovascular Medicine and the Stanford Cardiovascular Institute, Stanford University School of Medicine (J.-M.A., T.N., T.H., K.K., H.A., J.L., W.F.F.)
| | - Kuninobu Kashiyama
- Division of Cardiovascular Medicine and the Stanford Cardiovascular Institute, Stanford University School of Medicine (J.-M.A., T.N., T.H., K.K., H.A., J.L., W.F.F.)
| | - Hiroyuki Arashi
- Division of Cardiovascular Medicine and the Stanford Cardiovascular Institute, Stanford University School of Medicine (J.-M.A., T.N., T.H., K.K., H.A., J.L., W.F.F.)
| | - Jihoon Kweon
- Division of Cardiovascular Medicine and the Stanford Cardiovascular Institute, Stanford University School of Medicine (J.-M.A., T.N., T.H., K.K., H.A., J.L., W.F.F.).,Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (J.-M.A., J.K.)
| | - Marcel Van't Veer
- Department of Cardiology, Catharina Hospital Eindhoven, the Netherlands (M.v.V.).,Department of Biomedical Engineering, Eindhoven University of Technology, the Netherlands (M.v.V.)
| | - Jennifer Lyons
- Division of Cardiovascular Medicine and the Stanford Cardiovascular Institute, Stanford University School of Medicine (J.-M.A., T.N., T.H., K.K., H.A., J.L., W.F.F.)
| | - William F Fearon
- Division of Cardiovascular Medicine and the Stanford Cardiovascular Institute, Stanford University School of Medicine (J.-M.A., T.N., T.H., K.K., H.A., J.L., W.F.F.).,VA Palo Alto Health Care System, CA (W.F.F.)
| |
Collapse
|
12
|
Jeremias A, Nijjer S, Davies J, DiMario C. Physiologic Assessment and Guidance in the Cardiac Catheterization Laboratory. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
|
13
|
Yamaguchi M, Hoshino M, Sugiyama T, Kanaji Y, Nogami K, Nagamine T, Misawa T, Hada M, Araki M, Hamaya R, Usui E, Murai T, Lee T, Yonetsu T, Sasano T, Kakuta T. Preprocedural transthoracic Doppler echocardiography to identify stenosis associated with increased coronary flow after revascularisation. Sci Rep 2022; 12:1667. [PMID: 35102261 PMCID: PMC8803832 DOI: 10.1038/s41598-022-05683-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 01/17/2022] [Indexed: 11/09/2022] Open
Abstract
AbstractThe benefit of percutaneous coronary intervention (PCI) has been reported to be associated with functional stenosis severity defined by fractional flow reserve (FFR). This study aimed to investigate the predictive ability of preprocedural transthoracic Doppler echocardiography (TDE) for increased coronary flow. A total of 50 left anterior descending arteries (LAD) that underwent TDE examinations were analysed. Hyperaemic LAD diastolic peak velocity (hDPV) was used as a surrogate of volumetric coronary flow. The increase in coronary flow was evaluated by the metric of % hDPV-increase defined by 100× (post-PCI hDPV-pre-PCI hDPV)/pre-PCI hDPV. The two groups divided by the median value of % hDPV-increase were compared, and the determinants of a significant coronary flow increase defined as more than the median % hDPV-increase were explored. After PCI, FFR values improved in all cases. hDPV significantly increased from 53.0 to 76.0 mm/s (P < 0.01) and the median % hDPV-increase was 45%, while hDPV decreased in 10 patients. On multivariable analysis, pre-PCI FFR and hDPV were independent predictors of a significant coronary flow increase. Preprocedural TDE-derived hDPV provided significant improvement of identification of lesions that benefit from revascularisation with respect to significant coronary flow increase.
Collapse
|
14
|
Zhang J, Hwang D, Yang S, Kim CH, Lee JM, Nam CW, Shin ES, Doh JH, Hoshino M, Hamaya R, Kanaji Y, Murai T, Zhang JJ, Ye F, Li X, Ge Z, Chen SL, Kakuta T, Koo BK. Differential Prognostic Implications of Pre- and Post-Stent Fractional Flow Reserve in Patients Undergoing Percutaneous Coronary Intervention. Korean Circ J 2021; 52:47-59. [PMID: 34877828 PMCID: PMC8738713 DOI: 10.4070/kcj.2021.0128] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 08/10/2021] [Accepted: 09/01/2021] [Indexed: 01/10/2023] Open
Abstract
The current study showed that pre-percutaneous coronary intervention (PCI) fractional flow reserve (FFR) was associated with target vessel failure (TVF) after PCI. When the prognostic value of post-PCI FFR was evaluated according to pre-PCI FFR value, the risk of TVF significantly decreased along with the increase of post-PCI FFR in the low pre-PCI FFR group, but not in the high pre-PCI FFR group. Our study results suggest that patient prognosis can be varied according to the level of physiologic indices, both before and after PCI, and the integration of both information can provide better risk stratification after PCI. Background and Objectives The influence of pre-intervention coronary physiologic status on outcomes post percutaneous coronary intervention (PCI) is not well known. We sought to investigate the prognostic implications of pre-PCI fractional flow reserve (FFR) combined with post-PCI FFR. Methods A total of 1,479 PCI patients with pre-and post-PCI FFR data were analyzed. The patients were classified according to the median values of pre-PCI FFR (0.71) and post-PCI FFR (0.88). The primary outcome was target vessel failure (TVF) at 2 years. Results The risk of TVF was higher in the low pre-PCI FFR group than in the high pre-PCI FFR group (hazard ratio, 1.82; 95% confidence interval, 1.15–2.87; p=0.011). In 4 group comparisons, the cumulative incidences of TVF at 2 years were 3.8%, 4.1%, 4.8%, and 10.2% in the high pre-/high post-, low pre-/high post-, high pre-/low post-, and low pre-/low post-PCI FFR groups, respectively. The risk of TVF was the highest in the low pre-/low post-PCI FFR group among the groups (p values for comparisons <0.05). In addition, the high pre-/low post-PCI FFR group presented a comparable risk of TVF with the high post-PCI FFR groups (p values for comparison >0.05). When the prognostic value of the post-PCI FFR was evaluated according to the pre-PCI FFR, the risk of TVF significantly decreased with an increase in post-PCI FFR in the low pre-PCI FFR group, but not in the high pre-PCI FFR group. Conclusions Pre-PCI FFR was associated with clinical outcomes after PCI, and the prognostic value of post-PCI FFR differed according to the pre-PCI FFR. Trial Registration ClinicalTrials.gov Identifier: NCT04012281
Collapse
Affiliation(s)
- Jinlong Zhang
- Department of Cardiology, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Doyeon Hwang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Seokhun Yang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Chee Hae Kim
- Cardiovascular Center, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Joo Myung Lee
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chang-Wook Nam
- Department of Cardiology, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Eun-Seok Shin
- Division of Cardiology, Ulsan Hospital, Ulsan, Korea
| | - Joon-Hyung Doh
- Department of Cardiology, Inje University Ilsan Paik Hospital, Goyang, Korea.
| | - Masahiro Hoshino
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Rikuta Hamaya
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Yoshihisa Kanaji
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Tadashi Murai
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Jun-Jie Zhang
- Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Fei Ye
- Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Xiaobo Li
- Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Zhen Ge
- Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Shao-Liang Chen
- Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Tsunekazu Kakuta
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea.
| |
Collapse
|
15
|
Chang H, Kim HK, Shin D, Lim KS, Kim SU, Jeon CY, Lee HY, Lee Y, Won J, Lee SH, Kakuta T, Lee JM. Coronary Circulatory Indexes Before and After Percutaneous Coronary Intervention in a Porcine Tandem Stenoses Model. J Am Heart Assoc 2021; 10:e021824. [PMID: 34275325 PMCID: PMC8475665 DOI: 10.1161/jaha.121.021824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background In tandem stenoses, nonhyperemic pressure ratio pullback is the preferred method to fractional flow reserve (FFR), based on the assumption of stable resting coronary flow. This study aimed to evaluate temporal changes of coronary circulatory indexes in tandem stenoses before and after angioplasty for proximal stenosis. Methods and Results Coronary tandem stenoses were created by porcine restenosis model with 2 bare metal stents in the left anterior descending artery. Four weeks later, changes in distal coronary pressure (Pd), averaged peak velocity, microvascular resistance, transstenotic pressure gradient across distal stenosis, resting Pd/aortic pressure, and FFR were measured before and 1, 5, 10, 15, and 20 minutes after balloon angioplasty for proximal stenosis. After angioplasty, there were significant changes in both resting and hyperemic Pd, averaged peak velocity, microvascular resistance, and transstenotic pressure gradient across distal stenosis (all P values <0.01). After initial acute changes, hyperemic averaged peak velocity and microvascular resistance did not show significant difference from the baseline values (P=0.712 and 0.972, respectively). Conversely, resting averaged peak velocity remained increased (10.1±0.7 to 17.8±0.7; P<0.001) and resting microvascular resistance decreased (6.0±0.1 to 2.2±0.7; P<0.001). Transstenotic pressure gradient across distal stenosis was significantly increased in both resting (13.1±7.6 to 25.3±4.2; P=0.040) and hyperemic conditions (11.0±3.0 to 27.4±3.3 mm Hg; P<0.001). Actual post–percutaneous coronary intervention Pd/aortic pressure and FFR were significantly lower than predicted values (Pd/aortic pressure, 0.68±0.22 versus 0.85±0.14; P<0.001; FFR, 0.63±0.08 versus 0.81±0.08; P<0.001). Conclusions After angioplasty for proximal stenosis, transstenotic pressure gradient across distal stenosis showed similar changes between resting and hyperemic conditions. Both actual post–percutaneous coronary intervention resting Pd/aortic pressure and FFR were significantly lower than predicted values.
Collapse
Affiliation(s)
- Haseong Chang
- Division of Cardiology Department of Medicine Konkuk University Medical CenterSchool of MedicineKonkuk University Seoul Korea
| | - Hyun Kuk Kim
- Department of Internal Medicine and Cardiovascular Center Chosun University HospitalUniversity of Chosun College of Medicine Gwangju Korea
| | - Doosup Shin
- Division of Cardiovascular Medicine Department of Internal Medicine University of Iowa Carver College of Medicine IA
| | - Kyung Seob Lim
- Futuristic Animal Resource and Research Center & National Primate Research Center Korea Research Institute of Bioscience and Biotechnology Chungbuk Korea
| | - Sun-Uk Kim
- Futuristic Animal Resource and Research Center & National Primate Research Center Korea Research Institute of Bioscience and Biotechnology Chungbuk Korea
| | - Chang-Yeop Jeon
- Futuristic Animal Resource and Research Center & National Primate Research Center Korea Research Institute of Bioscience and Biotechnology Chungbuk Korea
| | - Hwal-Yong Lee
- Futuristic Animal Resource and Research Center & National Primate Research Center Korea Research Institute of Bioscience and Biotechnology Chungbuk Korea
| | - Youngjeon Lee
- Futuristic Animal Resource and Research Center & National Primate Research Center Korea Research Institute of Bioscience and Biotechnology Chungbuk Korea
| | - Jinyoung Won
- Futuristic Animal Resource and Research Center & National Primate Research Center Korea Research Institute of Bioscience and Biotechnology Chungbuk Korea
| | - Seung Hun Lee
- Department of Internal Medicine and Cardiovascular Center Chonnam National University Hospital Gwangju Korea
| | - Tsunekazu Kakuta
- Division of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki Japan
| | - Joo Myung Lee
- Division of Cardiology Department of Internal Medicine Heart Vascular Stroke InstituteSamsung Medical CenterSungkyunkwan University School of Medicine Seoul Korea
| |
Collapse
|
16
|
Aikawa T, Naya M, Koyanagawa K, Manabe O, Obara M, Magota K, Oyama-Manabe N, Tamaki N, Anzai T. Improved regional myocardial blood flow and flow reserve after coronary revascularization as assessed by serial 15O-water positron emission tomography/computed tomography. Eur Heart J Cardiovasc Imaging 2021; 21:36-46. [PMID: 31544927 DOI: 10.1093/ehjci/jez220] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 05/03/2019] [Accepted: 08/17/2019] [Indexed: 12/18/2022] Open
Abstract
AIMS Myocardial perfusion imaging without and with quantitative myocardial blood flow (MBF) and myocardial flow reserve (MFR) plays an important role in the diagnosis and risk stratification of patients with stable coronary artery disease (CAD). We aimed to quantify the effects of coronary revascularization on regional stress MBF and MFR and to determine whether the presence of subendocardial infarction was associated with these changes. METHODS AND RESULTS Forty-seven patients with stable CAD were prospectively enrolled. They underwent 15O-water positron emission tomography at baseline and 6 months after optimal medical therapy alone (n = 16), percutaneous coronary intervention (PCI) (n = 18), or coronary artery bypass grafting (CABG) (n = 13). Stenosis of ≥50% diameter was detected in 98/141 vessels (70%). The regional MFR was significantly increased from baseline to follow-up [1.84 (interquartile range, IQR 1.28-2.17) vs. 2.12 (IQR 1.69-2.63), P < 0.001] in vessel territories following PCI or CABG due to an increase in the stress MBF [1.33 (IQR 0.97-1.67) mL/g/min vs. 1.64 (IQR 1.38-2.17) mL/g/min, P < 0.001], whereas there was no significant change in the regional stress MBF or MFR in vessel territories without revascularization. A multilevel mixed-effects models adjusted for baseline characteristics, subendocardial infarction assessed by cardiovascular magnetic resonance imaging, and intra-patient correlation showed that the degree of angiographic improvement after coronary revascularization was significantly associated with increased regional stress MBF and MFR (P < 0.05 for all). CONCLUSION Coronary revascularization improved the regional stress MBF and MFR in patients with stable CAD. The magnitude of these changes was associated with the extent of revascularization independent of subendocardial infarction.
Collapse
Affiliation(s)
- Tadao Aikawa
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo, Japan.,Department of Minimally Invasive Advanced Heart Failure Therapeutics, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo, Japan
| | - Masanao Naya
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo, Japan
| | - Kazuhiro Koyanagawa
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo, Japan
| | - Osamu Manabe
- Department of Nuclear Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo, Japan
| | - Masahiko Obara
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo, Japan
| | - Keiichi Magota
- Division of Medical Imaging and Technology, Hokkaido University Hospital, Kita-14, Nishi-5, Kita-ku, Sapporo, Japan
| | - Noriko Oyama-Manabe
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Kita-14, Nishi-5, Kita-ku, Sapporo, Japan
| | - Nagara Tamaki
- Department of Radiology, Kyoto Prefectural University of Medicine, Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, Japan
| | - Toshihisa Anzai
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo, Japan
| |
Collapse
|
17
|
Lee JM, Lee SH, Shin D, Choi KH, van de Hoef TP, Kim HK, Samady H, Kakuta T, Matsuo H, Koo BK, Fearon WF, Escaned J. Physiology-Based Revascularization: A New Approach to Plan and Optimize Percutaneous Coronary Intervention. JACC. ASIA 2021; 1:14-36. [PMID: 36338358 PMCID: PMC9627934 DOI: 10.1016/j.jacasi.2021.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/17/2021] [Accepted: 03/20/2021] [Indexed: 06/12/2023]
Abstract
Coronary physiological assessment using fractional flow reserve or nonhyperemic pressure ratios has become a standard of care for patients with coronary atherosclerotic disease. However, most evidence has focused on the pre-interventional use of physiological assessment to aid revascularization decision-making, whereas post-interventional physiological assessment has not been well established. Although evidence for supporting the role of post-interventional physiological assessment to optimize immediate revascularization results and long-term prognosis has been reported, a more thorough understanding of these data is crucial in incorporating post-interventional physiological assessment into daily practice. Recent scientific efforts have also focused on the potential role of pre-interventional fractional flow reserve or nonhyperemic pressure ratio pullback tracings to characterize patterns of coronary atherosclerotic disease to better predict post-interventional physiological outcomes, and thereby identify the appropriate revascularization target. Pre-interventional pullback tracings with dedicated post-processing methods can provide characterization of focal versus diffuse disease or major gradient versus minor gradient stenosis, which would result in different post-interventional physiological results. This review provides a comprehensive look at the current evidence regarding the evolving role of physiological assessment as a functional optimization tool for the entire process of revascularization, and not merely as a pre-interventional tool for revascularization decision-making.
Collapse
Key Words
- CI, confidence interval
- DES, drug-eluting stent(s)
- FFR, fractional flow reserve
- HR, hazard ratio
- MACE, major adverse cardiac event(s)
- NHPR, nonhyperemic pressure ratio
- PCI, percutaneous coronary intervention
- TVF, target vessel failure
- VOCE, vessel-related composite event
- fractional flow reserve
- iFR, instantaneous wave-free ratio
- instantaneous wave-free ratio
- nonhyperemic pressure ratios
- percutaneous coronary intervention
- prognosis
Collapse
Affiliation(s)
- Joo Myung Lee
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seung Hun Lee
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Doosup Shin
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Ki Hong Choi
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Tim P. van de Hoef
- Department of Clinical and Experimental Cardiology, Amsterdam UMC–University of Amsterdam, Amsterdam, the Netherlands
| | - Hyun Kuk Kim
- Department of Internal Medicine and Cardiovascular Center, Chosun University Hospital, University of Chosun College of Medicine, Gwangju, Republic of Korea
| | - Habib Samady
- Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Tsunekazu Kakuta
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Hitoshi Matsuo
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - William F. Fearon
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California, USA
| | - Javier Escaned
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Madrid, Spain
| |
Collapse
|
18
|
FFR=1.0 flow changes after percutaneous coronary intervention. J Cardiol 2020; 77:634-640. [PMID: 33386218 DOI: 10.1016/j.jjcc.2020.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 11/12/2020] [Accepted: 11/30/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND The present study investigated the relationships between physiological indices and increased coronary flow during percutaneous coronary intervention (PCI) using a novel index of "anticipated maximum flow" [AMF; theoretical coronary flow of fractional flow reserve (FFR) = 1]. FFR-guided PCI aims to increase coronary flow, whereas recent studies have reported that PCI does not necessarily increase coronary flow despite improvement in FFR. METHODS This retrospective analysis was performed in 71 functionally significant lesions treated with elective PCI. AMF obtained by hyperemic average peak coronary flow velocity (h-APV) divided by FFR would not change after PCI given the constant microvascular resistance, which is the assumption of FFR as a surrogate of coronary flow. We evaluated the relationship between AMF and coronary flow during PCI. RESULTS Post-PCI AMF was significantly different from pre-PCI AMF (p = 0.022), which impacted discordance between FFR improvement and change in coronary flow. Coronary flow increase >50% was associated with smaller minimum lumen diameter (p = 0.010), greater diameter stenosis (p = 0.003), lower pre-PCI FFR (p < 0.001), lower pre-PCI coronary flow reserve (p = 0.001), higher pre-PCI hyperemic stenosis resistance (p < 0.001), lower pre-PCI h-APV (p = 0.001), and lower pre-PCI AMF (p = 0.031). Pre-PCI AMF provided significant incremental predictive capability for coronary flow increase >50% when added to the clinical model including pre-PCI FFR. CONCLUSION Pre-PCI AMF provided incremental ability to predict increased coronary flow after PCI and impacted the discordance between FFR improvement and increased coronary flow.
Collapse
|
19
|
Omori H, Kawase Y, Mizukami T, Tanigaki T, Hirata T, Kikuchi J, Ota H, Sobue Y, Miyake T, Kawamura I, Okubo M, Kamiya H, Hirakawa A, Kawasaki M, Nakagawa M, Tsuchiya K, Suzuki Y, Ito T, Terashima M, Kondo T, Suzuki T, Escaned J, Matsuo H. Comparisons of Nonhyperemic Pressure Ratios. JACC Cardiovasc Interv 2020; 13:2688-2698. [DOI: 10.1016/j.jcin.2020.06.060] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/22/2020] [Accepted: 06/30/2020] [Indexed: 01/10/2023]
|
20
|
Manabe O, Naya M, Aikawa T, Tamaki N. Recent advances in cardiac positron emission tomography for quantitative perfusion analyses and molecular imaging. Ann Nucl Med 2020; 34:697-706. [DOI: 10.1007/s12149-020-01519-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 08/31/2020] [Indexed: 12/12/2022]
|
21
|
Murai T, Stegehuis VE, van de Hoef TP, Wijntjens GWM, Hoshino M, Kanaji Y, Sugiyama T, Hamaya R, Nijjer SS, de Waard GA, Echavarria‐Pinto M, Knaapen P, Meuwissen M, Davies JE, van Royen N, Escaned J, Siebes M, Kirkeeide RL, Gould KL, Johnson NP, Piek JJ, Kakuta T. Coronary Flow Capacity to Identify Stenosis Associated With Coronary Flow Improvement After Revascularization: A Combined Analysis From DEFINE FLOW and IDEAL. J Am Heart Assoc 2020; 9:e016130. [PMID: 32660310 PMCID: PMC7660740 DOI: 10.1161/jaha.120.016130] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 05/29/2020] [Indexed: 01/09/2023]
Abstract
Background Coronary flow capacity (CFC), which is a categorical assessment based on the combination of hyperemic coronary flow and coronary flow reserve (CFR), has been introduced as a comprehensive assessment of the coronary circulation to overcome the limitations of CFR alone. The aim of this study was to quantify coronary flow changes after percutaneous coronary intervention in relation to the classification of CFC and the current physiological cutoff values of fractional flow reserve, instantaneous wave-free ratio, and CFR. Methods and Results Using the combined data set from DEFINE FLOW (Distal Evaluation of Functional Performance With Intravascular Sensors to Assess the Narrowing Effect -Combined Pressure and Doppler FLOW Velocity Measurements) and IDEAL (Iberian-Dutch-English), a total of 133 vessels that underwent intracoronary Doppler flow measurement before and after percutaneous coronary intervention were analyzed. CFC classified prerevascularization lesions as normal (14), mildly reduced (40), moderately reduced (31), and severely reduced (48). Lesions with larger impairment of CFC showed greater increase in coronary flow and vice versa (median percent increase in coronary flow by revascularization: 4.2%, 25.9%, 50.1%, and 145.5%, respectively; P<0.001). Compared with the conventional cutoff values of fractional flow reserve, instantaneous wave-free ratio, and CFR, an ischemic CFC defined as moderately to severely reduced CFC showed higher diagnostic accuracy with higher specificity to predict a >50% increase in coronary flow after percutaneous coronary intervention. Receiver operating characteristic curve analysis demonstrated that only CFC has a superior predictive efficacy to CFR (P<0.05). Multivariate analysis revealed lesions with ischemic CFC to be the independent predictor of a significant coronary flow increase after percutaneous coronary intervention (odds ratio, 10.7; 95% CI, 4.6-24.8; P<0.001). Conclusions CFC showed significant improvement of identification of lesions that benefit from revascularization compared with CFR with respect to coronary flow increase. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02328820.
Collapse
Affiliation(s)
| | | | | | | | - Masahiro Hoshino
- Department of Cardiovascular MedicineTsuchiura Kyodo General HospitalTsuchiuraIbarakiJapan
| | - Yoshihisa Kanaji
- Department of Cardiovascular MedicineTsuchiura Kyodo General HospitalTsuchiuraIbarakiJapan
| | - Tomoyo Sugiyama
- Department of Cardiovascular MedicineTsuchiura Kyodo General HospitalTsuchiuraIbarakiJapan
| | - Rikuta Hamaya
- Department of Cardiovascular MedicineTsuchiura Kyodo General HospitalTsuchiuraIbarakiJapan
| | - Sukhjinder S. Nijjer
- Department of CardiologyHammersmith HospitalImperial College Healthcare NHS TrustLondonUnited Kingdom
| | - Guus A. de Waard
- Department of CardiologyNuclear Medicine & PET ResearchAmsterdam UMCVrije UniversiteitAmsterdamThe Netherlands
| | | | - Paul Knaapen
- Department of CardiologyNuclear Medicine & PET ResearchAmsterdam UMCVrije UniversiteitAmsterdamThe Netherlands
| | | | - Justin E. Davies
- Department of CardiologyHammersmith HospitalImperial College Healthcare NHS TrustLondonUnited Kingdom
| | - Niels van Royen
- Department of CardiologyRadboud University Medical CenterNijmegenThe Netherlands
| | - Javier Escaned
- Department of CardiologyHospital Clinico San Carlos IDISSC, and Universidad Complutense de MadridMadridSpain
| | - Maria Siebes
- Department of Biomedical Engineering and PhysicsAmsterdam Cardiovascular SciencesAmsterdam UMCUniversity of AmsterdamThe Netherlands
| | - Richard L. Kirkeeide
- Division of CardiologyDepartment of MedicineWeatherhead PET Imaging CenterUniversity of Texas Medical School and Memorial Hermann HospitalHoustonTX
| | - K. Lance Gould
- Division of CardiologyDepartment of MedicineWeatherhead PET Imaging CenterUniversity of Texas Medical School and Memorial Hermann HospitalHoustonTX
| | - Nils P. Johnson
- Division of CardiologyDepartment of MedicineWeatherhead PET Imaging CenterUniversity of Texas Medical School and Memorial Hermann HospitalHoustonTX
| | - Jan J. Piek
- Heart CenterAmsterdam UMCAmsterdamThe Netherlands
| | - Tsunekazu Kakuta
- Department of Cardiovascular MedicineTsuchiura Kyodo General HospitalTsuchiuraIbarakiJapan
| |
Collapse
|
22
|
Matsuo A, Kasahara T, Ariyoshi M, Irie D, Isodono K, Tsubakimoto Y, Sakatani T, Inoue K, Fujita H. Utility of angiography-physiology coregistration maps during percutaneous coronary intervention in clinical practice. Cardiovasc Interv Ther 2020; 36:208-218. [PMID: 32507942 PMCID: PMC8019415 DOI: 10.1007/s12928-020-00668-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 04/16/2020] [Indexed: 01/22/2023]
Abstract
This study aimed to evaluate the utility and feasibility of physiological maps coregistered with angiograms using the pullback of a pressure guidewire with continuous instantaneous wave-free ratio (iFR) measurements. iFR pullback was obtained for 70 lesions from 70 patients with stable angina pectoris using SyncVision (Philips Corp.). Physiological maps were created, whereby the post-intervention iFR (post-iFR) was predicted as iFRpred. The iFR gap was defined if the difference between the iFRpred and post-iFR was ≥ 0.3. The lesion morphology changed from that during the physiological assessment to that during the angiographic assessment in 26 lesions (37.1%). In particular, 22.6% of angiographic tandem lesions changed to physiological focal lesions. The mean pre-intervention iFR, post-iFR, and iFRpred were 0.73 ± 0.17, 0.90 ± 0.06, and 0.93 ± 0.05, respectively. The mean difference between the iFRpred and post-iFR was 0.029 ± 0.099, with 95% limits of agreement of -0.070–0.128. iFR gaps occurred in 28 patients (40%). Notably, a new iFR gradient causing a ≥ 0.03 iFR drop after stenting occurred in 11 (15.7%) cases. The study patients were divided into two groups according to biases between post-iFR and iFRpred < 0.03 (good concordance group) or ≥ 0.03 (poor concordance group). The pre-intervention heart rate was the only independent predictor of poor concordance (odds ratio, 0.936; 95% confidence interval 0.883–0.992; p = 0.027). Physiological maps under resting conditions may contribute to a reduction in unnecessary stent placements without missing lesions requiring treatment. However, the predictive accuracy of post-iFR performance in the present study was slightly lower than that in the previous reports.
Collapse
Affiliation(s)
- Akiko Matsuo
- Department of Cardiology, Japanese Red Cross Kyoto Daini Hospital, 355-5 Haruobi-cho, Kamanzadorimarutamachi, Kamigyo-ku, Kyoto, 602-8026, Japan.
| | - Takeru Kasahara
- Department of Cardiology, Japanese Red Cross Kyoto Daini Hospital, 355-5 Haruobi-cho, Kamanzadorimarutamachi, Kamigyo-ku, Kyoto, 602-8026, Japan
| | - Makoto Ariyoshi
- Department of Cardiology, Japanese Red Cross Kyoto Daini Hospital, 355-5 Haruobi-cho, Kamanzadorimarutamachi, Kamigyo-ku, Kyoto, 602-8026, Japan
| | - Daisuke Irie
- Department of Cardiology, Japanese Red Cross Kyoto Daini Hospital, 355-5 Haruobi-cho, Kamanzadorimarutamachi, Kamigyo-ku, Kyoto, 602-8026, Japan
| | - Koji Isodono
- Department of Cardiology, Japanese Red Cross Kyoto Daini Hospital, 355-5 Haruobi-cho, Kamanzadorimarutamachi, Kamigyo-ku, Kyoto, 602-8026, Japan
| | - Yoshinori Tsubakimoto
- Department of Cardiology, Japanese Red Cross Kyoto Daini Hospital, 355-5 Haruobi-cho, Kamanzadorimarutamachi, Kamigyo-ku, Kyoto, 602-8026, Japan
| | - Tomohiko Sakatani
- Department of Cardiology, Japanese Red Cross Kyoto Daini Hospital, 355-5 Haruobi-cho, Kamanzadorimarutamachi, Kamigyo-ku, Kyoto, 602-8026, Japan
| | - Keiji Inoue
- Department of Cardiology, Japanese Red Cross Kyoto Daini Hospital, 355-5 Haruobi-cho, Kamanzadorimarutamachi, Kamigyo-ku, Kyoto, 602-8026, Japan
| | - Hiroshi Fujita
- Department of Cardiology, Japanese Red Cross Kyoto Daini Hospital, 355-5 Haruobi-cho, Kamanzadorimarutamachi, Kamigyo-ku, Kyoto, 602-8026, Japan
| |
Collapse
|
23
|
Abstract
PURPOSE OF REVIEW Adequate tissue perfusion is of utmost importance to avoid organ failure in patients with cardiogenic shock. Within the recent years, the microcirculation, defined as the perfusion of the smallest vessels, has been identified to play a crucial role. Microcirculatory changes may include capillary flow disturbances as well as changes in the density of perfused vessels. Due to the availability of new technologies to assess the microcirculation, interesting new data came up and it is the purpose of this review to summarize recent studies in the field. RECENT FINDINGS Nowadays, an increasing number of studies confirm parameters of the microcirculation, derived by intravital microscopy, to represent strong outcome predictors in cardiogenic shock. In addition, microcirculation as read-out parameter in innovative clinical studies has meanwhile been accepted as serious endpoint. Treatment strategies such as mechanical assist devices, blood pressure regulating agents or fluids use tissue perfusion and microcirculatory network density as targets in addition to clinical perfusion evaluation and decreasing serum lactate levels. SUMMARY The parameter most frequently used to detect tissue malperfusion is serum lactate. Novel, noninvasive methods to quantify microvascular perfusion have the potential to guide treatment in terms of optimizing organ perfusion and oxygenation probably paving the way for an individualized therapy.
Collapse
|
24
|
Aikawa T, Naya M, Obara M, Manabe O, Magota K, Koyanagawa K, Asakawa N, Ito YM, Shiga T, Katoh C, Anzai T, Tsutsui H, Murthy VL, Tamaki N. Effects of coronary revascularization on global coronary flow reserve in stable coronary artery disease. Cardiovasc Res 2020; 115:119-129. [PMID: 29992275 PMCID: PMC6302265 DOI: 10.1093/cvr/cvy169] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 07/09/2018] [Indexed: 01/09/2023] Open
Abstract
Aims Coronary flow reserve (CFR) is an integrated measure of the entire coronary vasculature, and is a powerful prognostic marker in coronary artery disease (CAD). The extent to which coronary revascularization can improve CFR is unclear. This study aimed to evaluate the impact of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) on CFR in patients with stable CAD. Methods and results In a prospective, multicentre observational study, CFR was measured by 15O-water positron emission tomography as the ratio of stress to rest myocardial blood flow at baseline and 6 months after optimal medical therapy (OMT) alone, PCI, or CABG. Changes in the SYNTAX and Leaman scores were angiographically evaluated as indicators of completeness of revascularization. Follow-up was completed by 75 (25 OMT alone, 28 PCI, and 22 CABG) out of 82 patients. The median SYNTAX and Leaman scores, and baseline CFR were 14.5 [interquartile range (IQR): 8–24.5], 5.5 (IQR: 2.5–12.5), and 1.94 (IQR: 1.67–2.66), respectively. Baseline CFR was negatively correlated with the SYNTAX (ρ = −0.40, P < 0.001) and Leaman scores (ρ = −0.33, P = 0.004). Overall, only CABG was associated with a significant increase in CFR [1.67 (IQR: 1.14–1.96) vs. 1.98 (IQR: 1.60–2.39), P < 0.001]. Among patients with CFR <2.0 (n = 41), CFR significantly increased in the PCI [1.70 (IQR: 1.42–1.79) vs. 2.21 (IQR: 1.78–2.49), P = 0.002, P < 0.001 for interaction between time and CFR] and CABG groups [1.28 (IQR: 1.13–1.80) vs. 1.86 (IQR: 1.57–2.22), P < 0.001]. The reduction in SYNTAX or Leaman scores after PCI or CABG was independently associated with the percent increase in CFR after adjusting for baseline characteristics (P = 0.012 and P = 0.011, respectively). Conclusion Coronary revascularization ameliorated reduced CFR in patients with obstructive CAD. The degree of improvement in angiographic CAD burden by revascularization was correlated with magnitude of improvement in CFR.
Collapse
Affiliation(s)
- Tadao Aikawa
- Department of Cardiovascular Medicine, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo, Japan
| | - Masanao Naya
- Department of Cardiovascular Medicine, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo, Japan
- Corresponding author. Tel: +81 11 706 6973; fax: +81 11 706 7874, E-mail:
| | - Masahiko Obara
- Department of Cardiovascular Medicine, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo, Japan
| | - Osamu Manabe
- Department of Nuclear Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo, Japan
| | - Keiichi Magota
- Division of Medical Imaging and Technology, Hokkaido University Hospital, Sapporo, Japan, Kita-14, Nishi-5, Kita-ku, Sapporo, Japan
| | - Kazuhiro Koyanagawa
- Department of Cardiovascular Medicine, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo, Japan
| | - Naoya Asakawa
- Department of Cardiovascular Medicine, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo, Japan
| | - Yoichi M Ito
- Department of Biostatistics, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo, Japan
| | - Tohru Shiga
- Department of Nuclear Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo, Japan
| | - Chietsugu Katoh
- Department of Biomedical Science and Engineering, Faculty of Health Sciences, Hokkaido University, Kita-12, Nishi-5, Kita-ku, Sapporo, Japan
| | - Toshihisa Anzai
- Department of Cardiovascular Medicine, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo, Japan
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, Japan
| | - Venkatesh L Murthy
- Divisions of Nuclear Medicine, Cardiothoracic Imaging, and Cardiovascular Medicine, Departments of Medicine and Radiology, University of Michigan, 1500 E Medical Center, Ann Arbor, MI, USA
| | - Nagara Tamaki
- Department of Radiology, Kyoto Prefectural University of Medicine, Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, Japan
| |
Collapse
|
25
|
Usui E, Murai T, Kanaji Y, Hoshino M, Yamaguchi M, Hada M, Hamaya R, Kanno Y, Lee T, Yonetsu T, Kakuta T. Clinical significance of concordance or discordance between fractional flow reserve and coronary flow reserve for coronary physiological indices, microvascular resistance, and prognosis after elective percutaneous coronary intervention. EUROINTERVENTION 2019; 14:798-805. [PMID: 29336308 DOI: 10.4244/eij-d-17-00449] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS We aimed to investigate the impact of concordance or discordance of fractional flow reserve (FFR) and coronary flow reserve (CFR) on coronary flow profiles and microvascular resistance after percutaneous coronary intervention (PCI), and the prognostic impact of the periprocedural physiological indices. METHODS AND RESULTS A total of 249 de novo physiologically significant coronary lesions from 231 patients who underwent FFR, CFR, and index of microcirculatory resistance (IMR) examinations before and after PCI were included. Baseline characteristics and physiological indices were compared between the concordant (FFR ≤0.80 and CFR <2.0, n=114) and discordant (FFR ≤0.80 and CFR ≥2.0, n=135) groups. Follow-up data were collected to determine predictors of cardiac events. Shortening of the mean transit time, CFR improvement, and decrease in the hyperaemic IMR were all significantly greater in the concordant territories. Cox proportional hazards analysis showed that a lower pre-PCI CFR was an independent predictor of adverse events at a median follow-up of 26.5 months, whereas neither the pre- nor post-PCI FFR was predictive of events. Event-free survival was significantly worse in patients with a lower pre-PCI CFR. CONCLUSIONS FFR/CFR concordantly abnormal territories provide a favourable benefit as assessed by coronary physiological indices after elective PCI. The pre-PCI CFR may predict adverse cardiac events.
Collapse
Affiliation(s)
- Eisuke Usui
- Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Pelletier-Galarneau M, Ruddy TD. The potential for PET-guided revascularization of coronary artery disease. Eur J Nucl Med Mol Imaging 2019; 46:1218-1221. [DOI: 10.1007/s00259-019-04316-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 03/21/2019] [Indexed: 10/27/2022]
|
27
|
Okuya Y, Seike F, Yoneda K, Takahashi T, Kishi K, Hiasa Y. Functional assessment of tandem coronary artery stenosis by intracoronary optical coherence tomography-derived virtual fractional flow reserve: a case series. EUROPEAN HEART JOURNAL-CASE REPORTS 2019; 3:5498066. [PMID: 31449634 PMCID: PMC6601174 DOI: 10.1093/ehjcr/ytz087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 02/08/2019] [Accepted: 05/06/2019] [Indexed: 01/17/2023]
Abstract
Background Optical coherence tomography (OCT)-derived fractional flow reserve (FFR)—which may be calculated using fluid dynamics—demonstrated an excellent correlation with the wire-based FFR. However, the applicability of the OCT-derived FFR in the assessment of tandem lesions is currently unclear. Case summary We present two cases of tandem lesions in the mid segment of the left anterior descending (LAD) artery which could have assessed accurately by OCT-derived FFR. The first patient underwent wire-based FFR at the far distal site of LAD, showed a value of 0.66. The OCT-derived FFR was calculated, yielding a value of 0.64. In the absence of stenosis at the proximal lesion, the OCT-derived FFR was calculated as 0.79, which was as same as the wire-based FFR obtained after stenting to the proximal lesion. Thus, additional stenting was performed at the distal lesion. The second patient underwent wire-based FFR at the far distal site of LAD, showed a value of 0.76 which was as same vale as OCT-derived FFR. Considering the absence of stenosis in the proximal lesion, the OCT-derived FFR was estimated as 0.88. After coronary stenting in the proximal lesion, the wire-based FFR yielded a value of 0.90. Therefore, additional intervention to the distal lesion was deferred. Discussion The described reports are the first two cases which performed physiological assessment using OCT in tandem lesions. The OCT-derived FFR might be able to estimate the wire-based FFR and the severity of each individual lesion in patients with tandem lesions.
Collapse
Affiliation(s)
- Yoshiyuki Okuya
- Department of Cardiovascular Medicine, Tokushima Red Cross Hospital, 103 Irinoguchi, Komatsushima-cho, Komatsushima, Tokushima, Japan
| | - Fumiyasu Seike
- Department of Cardiology, Pulmonology, Hypertension, and Nephrology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Kohei Yoneda
- Department of Cardiovascular Medicine, Tokushima Red Cross Hospital, 103 Irinoguchi, Komatsushima-cho, Komatsushima, Tokushima, Japan
| | - Takefumi Takahashi
- Department of Cardiovascular Medicine, Tokushima Red Cross Hospital, 103 Irinoguchi, Komatsushima-cho, Komatsushima, Tokushima, Japan
| | - Koichi Kishi
- Department of Cardiovascular Medicine, Tokushima Red Cross Hospital, 103 Irinoguchi, Komatsushima-cho, Komatsushima, Tokushima, Japan
| | - Yoshikazu Hiasa
- Department of Cardiovascular Medicine, Tokushima Red Cross Hospital, 103 Irinoguchi, Komatsushima-cho, Komatsushima, Tokushima, Japan
| |
Collapse
|
28
|
The impact of revascularization on myocardial blood flow as assessed by positron emission tomography. Eur J Nucl Med Mol Imaging 2019; 46:1226-1239. [PMID: 30806750 PMCID: PMC6486946 DOI: 10.1007/s00259-019-04278-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 01/23/2019] [Indexed: 11/30/2022]
Abstract
Purpose Revascularization aims to improve myocardial perfusion. However, changes in regional artery-specific quantitative perfusion after revascularization have not been systematically investigated. It is unclear whether artery-specific thresholds for coronary flow capacity (CFC) and/or relative perfusion predict improved stress perfusion after revascularization. We sought to determine the impact of revascularization based on predefined, artery-specific, severity size thresholds for CFC and/or relative perfusion defects. Methods Fifty patients underwent PET imaging before revascularization and then prospectively within 90 days after revascularization. Changes in regional myocardial blood flow (MBF) were stratified based on baseline perfusion abnormalities, baseline reduced CFC, and whether revascularization was performed in that region. Results Following angiographic stenosis-directed revascularization, in regions with relative perfusion abnormalities and decreased CFC, stress MBF (sMBF) increased by 0.51 cm3/min/g (59%) from baseline (p < 0.001). In regions without baseline perfusion abnormalities and yet decreased CFC, sMBF increased by 0.35 cm3/min/g (40%) from baseline (p < 0.001). In regions without perfusion abnormalities and normal CFC, sMBF did not increase significantly (+0.07 cm3/min/g, p = 0.56). Patients in whom revascularization was concordant with abnormal PET findings showed increased whole-heart sMBF (+0.22 cm3/min/g, p < 0.001), but in patients in whom revascularization was targeted only to regions without perfusion abnormalities or low CFC, sMBF did not change significantly (−0.06 cm3/min/g, p = 0.38). Conclusion Revascularization targeted to regions with reduced CFC and relative perfusion abnormalities on baseline PET yielded significant improvements in sMBF. When revascularization was performed in regions without reduced CFC, sMBF did not improve. Electronic supplementary material The online version of this article (10.1007/s00259-019-04278-8) contains supplementary material, which is available to authorized users.
Collapse
|
29
|
Garcia D, Harbaoui B, van de Hoef TP, Meuwissen M, Nijjer SS, Echavarria-Pinto M, Davies JE, Piek JJ, Lantelme P. Relationship between FFR, CFR and coronary microvascular resistance - Practical implications for FFR-guided percutaneous coronary intervention. PLoS One 2019; 14:e0208612. [PMID: 30616240 PMCID: PMC6322913 DOI: 10.1371/journal.pone.0208612] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 11/20/2018] [Indexed: 01/09/2023] Open
Abstract
Objective The aim was threefold: 1) expound the independent physiological parameters that drive FFR, 2) elucidate contradictory conclusions between fractional flow reserve (FFR) and coronary flow reserve (CFR), and 3) highlight the need of both FFR and CFR in clinical decision making. Simple explicit theoretical models were supported by coronary data analyzed retrospectively. Methodology FFR was expressed as a function of pressure loss coefficient, aortic pressure and hyperemic coronary microvascular resistance. The FFR-CFR relationship was also demonstrated mathematically and was shown to be exclusively dependent upon the coronary microvascular resistances. The equations were validated in a first series of 199 lesions whose pressures and distal velocities were monitored. A second dataset of 75 lesions with pre- and post-PCI measures of FFR and CFR was also analyzed to investigate the clinical impact of our hemodynamic reasoning. Results Hyperemic coronary microvascular resistance and pressure loss coefficient had comparable impacts (45% and 49%) on FFR. There was a good concordance (y = 0.96 x − 0.02, r2 = 0.97) between measured CFR and CFR predicted by FFR and coronary resistances. In patients with CFR < 2 and CFR/FFR ≥ 2, post-PCI CFR was significantly >2 (p < 0.001), whereas it was not (p = 0.94) in patients with CFR < 2 and CFR/FFR < 2. Conclusion The FFR behavior and FFR-CFR relationship are predictable from basic hemodynamics. Conflicting conclusions between FFR and CFR are explained from coronary vascular resistances. As confirmed by our results, FFR and CFR are complementary; they could jointly contribute to better PCI guidance through the CFR-to-FFR ratio in patients with coronary artery disease.
Collapse
Affiliation(s)
- Damien Garcia
- CREATIS, INSERM U1206, Université Lyon 1, INSA Lyon, Villeurbanne, France
- * E-mail: ,
| | - Brahim Harbaoui
- CREATIS, INSERM U1206, Université Lyon 1, INSA Lyon, Villeurbanne, France
- Department of Cardiology, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, France
| | - Tim P. van de Hoef
- AMC Heart Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Department of Cardiology, Tergooi Hospital, Blaricum, The Netherlands
| | | | | | - Mauro Echavarria-Pinto
- AMC Heart Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Justin E. Davies
- Department of Cardiology, Tergooi Hospital, Blaricum, The Netherlands
| | - Jan J. Piek
- AMC Heart Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Pierre Lantelme
- CREATIS, INSERM U1206, Université Lyon 1, INSA Lyon, Villeurbanne, France
- Department of Cardiology, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, France
| |
Collapse
|
30
|
Djordjevic Dikic A, Tesic M, Boskovic N, Giga V, Stepanovic J, Petrovic M, Dobric M, Aleksandric S, Juricic S, Dikic M, Nedeljkovic I, Nedeljkovic M, Ostojic M, Beleslin B. Prognostic Value of Preserved Coronary Flow Velocity Reserve by Noninvasive Transthoracic Doppler Echocardiography in Patients With Angiographically Intermediate Left Main Stenosis. J Am Soc Echocardiogr 2018; 32:74-80. [PMID: 30459120 DOI: 10.1016/j.echo.2018.09.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND The potential of angiography to evaluate the hemodynamic severity of a left main coronary artery (LM) stenosis is limited. Noninvasive transthoracic Doppler echocardiographic coronary flow velocity reserve (CFVR) evaluation of intermediate coronary stenosis has demonstrated remarkably high negative prognostic value. The aim of this study was to assess clinical outcomes in patients with angiographically intermediate LM stenosis and preserved CFVR (>2.0) as evaluated by transthoracic Doppler echocardiographic CFVR. METHODS The initial study population included 102 patients with intermediate coronary stenosis of the LM referred for transthoracic Doppler echocardiographic CFVR assessment. Peak diastolic CFVR measurements were performed in the distal segment of the left anterior descending coronary artery after intravenous adenosine (140 μg/kg/min), and CFVR was calculated as the ratio between maximal hyperemic and baseline coronary flow velocity. Nineteen patients had impaired CFVR (≤2.0) and were excluded from further analysis, as well as two patients with poor acoustic windows. The final group consisted of 81 patients (mean age, 60 ± 9 years; 76 men) evaluated for adverse cardiac events including death, myocardial infarction, and revascularization. RESULTS Mean follow-up duration was 62 ± 26 months. Mean CFVR was 2.4 ± 0.4. Total event-free survival was 75 of 81 (92.6%), as six patients were referred for revascularization (five patients with coronary artery bypass grafting, one patient with percutaneous coronary intervention). There were no documented myocardial infarctions or cardiovascular deaths in the follow-up period. CONCLUSIONS In patients with angiographically intermediate and equivocal LM stenosis and preserved CFVR values of >2.0, revascularization can be safely deferred.
Collapse
Affiliation(s)
- Ana Djordjevic Dikic
- Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia; Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Milorad Tesic
- Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia; Medical Faculty, University of Belgrade, Belgrade, Serbia
| | | | - Vojislav Giga
- Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia; Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Jelena Stepanovic
- Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia; Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Marija Petrovic
- Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia
| | - Milan Dobric
- Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia; Medical Faculty, University of Belgrade, Belgrade, Serbia
| | | | - Stefan Juricic
- Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia
| | - Miodrag Dikic
- Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia
| | - Ivana Nedeljkovic
- Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia; Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Milan Nedeljkovic
- Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia; Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Miodrag Ostojic
- Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia; Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Branko Beleslin
- Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia; Medical Faculty, University of Belgrade, Belgrade, Serbia.
| |
Collapse
|
31
|
Modi BN, Ryan M, Chattersingh A, Eruslanova K, Ellis H, Gaddum N, Lee J, Clapp B, Chowienczyk P, Perera D. Optimal Application of Fractional Flow Reserve to Assess Serial Coronary Artery Disease: A 3D-Printed Experimental Study With Clinical Validation. J Am Heart Assoc 2018; 7:e010279. [PMID: 30371265 PMCID: PMC6474982 DOI: 10.1161/jaha.118.010279] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 08/20/2018] [Indexed: 01/10/2023]
Abstract
Background Assessing the physiological significance of stenoses with coexistent serial disease is prone to error. We aimed to use 3-dimensional-printing to characterize serial stenosis interplay and to derive and validate a mathematical solution to predict true stenosis significance in serial disease. Methods and Results Fifty-two 3-dimensional-printed serial disease phantoms were physiologically assessed by pressure-wire pullback (Δ FFR app) and compared with phantoms with the stenosis in isolation (Δ FFR true). Mathematical models to minimize error in predicting FFR true, the FFR in the vessel where the stenosis is present in isolation, were subsequently developed using 32 phantoms and validated in another 20 and also a clinical cohort of 30 patients with serial disease. Δ FFR app underestimated Δ FFR true in 88% of phantoms, with underestimation proportional to total FFR . Discrepancy as a proportion of Δ FFR true was 17.1% (absolute difference 0.036±0.048), which improved to 2.9% (0.006±0.023) using our model. In the clinical cohort, discrepancy was 38.5% (0.05±0.04) with 13.3% of stenoses misclassified (using FFR <0.8 threshold). Using mathematical correction, this improved to 15.4% (0.02±0.03), with the proportion of misclassified stenoses falling to 6.7%. Conclusions Individual stenoses are considerably underestimated in serial disease, proportional to total FFR . We have shown within in vitro and clinical cohorts that this error is significantly improved using a mathematical correction model, incorporating routinely available pressure-wire pullback data.
Collapse
Affiliation(s)
- Bhavik N. Modi
- NIHR Biomedical Research Centre and British Heart Foundation Centre of ExcellenceSchool of Cardiovascular Medicine and SciencesSt Thomas’ CampusKing's College LondonLondonUnited Kingdom
| | - Matthew Ryan
- NIHR Biomedical Research Centre and British Heart Foundation Centre of ExcellenceSchool of Cardiovascular Medicine and SciencesSt Thomas’ CampusKing's College LondonLondonUnited Kingdom
| | - Anjalee Chattersingh
- NIHR Biomedical Research Centre and British Heart Foundation Centre of ExcellenceSchool of Cardiovascular Medicine and SciencesSt Thomas’ CampusKing's College LondonLondonUnited Kingdom
| | - Kseniia Eruslanova
- NIHR Biomedical Research Centre and British Heart Foundation Centre of ExcellenceSchool of Cardiovascular Medicine and SciencesSt Thomas’ CampusKing's College LondonLondonUnited Kingdom
| | - Howard Ellis
- NIHR Biomedical Research Centre and British Heart Foundation Centre of ExcellenceSchool of Cardiovascular Medicine and SciencesSt Thomas’ CampusKing's College LondonLondonUnited Kingdom
| | - Nicholas Gaddum
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUnited Kingdom
| | - Jack Lee
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUnited Kingdom
| | - Brian Clapp
- NIHR Biomedical Research Centre and British Heart Foundation Centre of ExcellenceSchool of Cardiovascular Medicine and SciencesSt Thomas’ CampusKing's College LondonLondonUnited Kingdom
| | - Phil Chowienczyk
- NIHR Biomedical Research Centre and British Heart Foundation Centre of ExcellenceSchool of Cardiovascular Medicine and SciencesSt Thomas’ CampusKing's College LondonLondonUnited Kingdom
| | - Divaka Perera
- NIHR Biomedical Research Centre and British Heart Foundation Centre of ExcellenceSchool of Cardiovascular Medicine and SciencesSt Thomas’ CampusKing's College LondonLondonUnited Kingdom
| |
Collapse
|
32
|
Kanaji Y, Yonetsu T, Hamaya R, Murai T, Usui E, Hoshino M, Yamaguchi M, Hada M, Kanno Y, Fukuda T, Ohya H, Sumino Y, Sugano A, Lee T, Hirao K, Kakuta T. Impact of Elective Percutaneous Coronary Intervention on Global Absolute Coronary Flow and Flow Reserve Evaluated by Phase-Contrast Cine-Magnetic Resonance Imaging in Relation to Regional Invasive Physiological Indices. Circ Cardiovasc Interv 2018; 11:e006676. [DOI: 10.1161/circinterventions.118.006676] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Accepted: 05/31/2018] [Indexed: 11/16/2022]
Abstract
Background:
Few studies have documented changes in global absolute coronary blood flow and global coronary flow reserve after percutaneous coronary intervention (PCI) in relation to regional physiological measures. Phase-contrast cine-magnetic resonance of the coronary sinus is a promising approach to quantify global absolute coronary blood flow. We aimed to assess the impact of elective PCI on global absolute coronary blood flow and global coronary flow reserve by quantifying coronary sinus flow (CSF) using phase-contrast cine-magnetic resonance in relation to regional physiological indices.
Methods and Results:
We prospectively studied 54 patients with stable angina undergoing elective PCI for a single proximal lesion. Phase-contrast cine-magnetic resonance was used to assess CSF and CSF reserve at rest and during maximum hyperemia, before and after PCI. Regional physiological indices were obtained during PCI. A complete data set was obtained in 50 patients. Hyperemic CSF increased significantly after PCI (pre-PCI, 230.2 [167.4–282.8] mL/min; post-PCI, 267.4 [224.1–346.2] mL/min;
P
<0.01), although 12 patients (24.0%) showed a decrease, despite successful PCI and improved fractional flow reserve. CSF reserve numerically, albeit not statistically significant (
P
=0.19), increased from 2.65 (1.95–3.96) to 2.98 (2.13–4.32). Patients with decreased CSF after PCI were associated with significantly greater pre-PCI hyperemic CSF, lower global coronary vascular resistance, lower regional microcirculatory resistance, and higher fractional flow reserve (all
P
<0.01).
Conclusions:
Fractional flow reserve–guided PCI in patients with single de novo lesions was associated with increased absolute hyperemic CSF, although 24% of patients showed decreased hyperemic CSF, despite successful and uncomplicated PCI. The present approach combining regional and global physiological assessments may provide a novel insight into the dynamic behavior of the coronary hemodynamics and microvascular function after PCI.
Collapse
Affiliation(s)
- Yoshihisa Kanaji
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan (Y. Kanaji, T.Y., R.H., T.M., E.U., M. Hoshino, M.Y., M. Hada, Y. Kanno, T.F., H.O., Y.S., A.S., T.L., T.K.)
| | - Taishi Yonetsu
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan (Y. Kanaji, T.Y., R.H., T.M., E.U., M. Hoshino, M.Y., M. Hada, Y. Kanno, T.F., H.O., Y.S., A.S., T.L., T.K.)
| | - Rikuta Hamaya
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan (Y. Kanaji, T.Y., R.H., T.M., E.U., M. Hoshino, M.Y., M. Hada, Y. Kanno, T.F., H.O., Y.S., A.S., T.L., T.K.)
| | - Tadashi Murai
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan (Y. Kanaji, T.Y., R.H., T.M., E.U., M. Hoshino, M.Y., M. Hada, Y. Kanno, T.F., H.O., Y.S., A.S., T.L., T.K.)
| | - Eisuke Usui
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan (Y. Kanaji, T.Y., R.H., T.M., E.U., M. Hoshino, M.Y., M. Hada, Y. Kanno, T.F., H.O., Y.S., A.S., T.L., T.K.)
| | - Masahiro Hoshino
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan (Y. Kanaji, T.Y., R.H., T.M., E.U., M. Hoshino, M.Y., M. Hada, Y. Kanno, T.F., H.O., Y.S., A.S., T.L., T.K.)
| | - Masao Yamaguchi
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan (Y. Kanaji, T.Y., R.H., T.M., E.U., M. Hoshino, M.Y., M. Hada, Y. Kanno, T.F., H.O., Y.S., A.S., T.L., T.K.)
| | - Masahiro Hada
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan (Y. Kanaji, T.Y., R.H., T.M., E.U., M. Hoshino, M.Y., M. Hada, Y. Kanno, T.F., H.O., Y.S., A.S., T.L., T.K.)
| | - Yoshinori Kanno
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan (Y. Kanaji, T.Y., R.H., T.M., E.U., M. Hoshino, M.Y., M. Hada, Y. Kanno, T.F., H.O., Y.S., A.S., T.L., T.K.)
| | - Tadashi Fukuda
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan (Y. Kanaji, T.Y., R.H., T.M., E.U., M. Hoshino, M.Y., M. Hada, Y. Kanno, T.F., H.O., Y.S., A.S., T.L., T.K.)
| | - Hiroaki Ohya
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan (Y. Kanaji, T.Y., R.H., T.M., E.U., M. Hoshino, M.Y., M. Hada, Y. Kanno, T.F., H.O., Y.S., A.S., T.L., T.K.)
| | - Youhei Sumino
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan (Y. Kanaji, T.Y., R.H., T.M., E.U., M. Hoshino, M.Y., M. Hada, Y. Kanno, T.F., H.O., Y.S., A.S., T.L., T.K.)
| | - Akinori Sugano
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan (Y. Kanaji, T.Y., R.H., T.M., E.U., M. Hoshino, M.Y., M. Hada, Y. Kanno, T.F., H.O., Y.S., A.S., T.L., T.K.)
| | - Tetsumin Lee
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan (Y. Kanaji, T.Y., R.H., T.M., E.U., M. Hoshino, M.Y., M. Hada, Y. Kanno, T.F., H.O., Y.S., A.S., T.L., T.K.)
| | - Kenzo Hirao
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan (K.H.)
| | - Tsunekazu Kakuta
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan (Y. Kanaji, T.Y., R.H., T.M., E.U., M. Hoshino, M.Y., M. Hada, Y. Kanno, T.F., H.O., Y.S., A.S., T.L., T.K.)
| |
Collapse
|
33
|
Kikuta Y, Cook CM, Sharp ASP, Salinas P, Kawase Y, Shiono Y, Giavarini A, Nakayama M, De Rosa S, Sen S, Nijjer SS, Al-Lamee R, Petraco R, Malik IS, Mikhail GW, Kaprielian RR, Wijntjens GWM, Mori S, Hagikura A, Mates M, Mizuno A, Hellig F, Lee K, Janssens L, Horie K, Mohdnazri S, Herrera R, Krackhardt F, Yamawaki M, Davies J, Takebayashi H, Keeble T, Haruta S, Ribichini F, Indolfi C, Mayet J, Francis DP, Piek JJ, Di Mario C, Escaned J, Matsuo H, Davies JE. Pre-Angioplasty Instantaneous Wave-Free Ratio Pullback Predicts Hemodynamic Outcome In Humans With Coronary Artery Disease: Primary Results of the International Multicenter iFR GRADIENT Registry. JACC Cardiovasc Interv 2018; 11:757-767. [PMID: 29673507 DOI: 10.1016/j.jcin.2018.03.005] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 03/01/2018] [Accepted: 03/06/2018] [Indexed: 01/10/2023]
Abstract
OBJECTIVES The authors sought to evaluate the accuracy of instantaneous wave-Free Ratio (iFR) pullback measurements to predict post-percutaneous coronary intervention (PCI) physiological outcomes, and to quantify how often iFR pullback alters PCI strategy in real-world clinical settings. BACKGROUND In tandem and diffuse disease, offline analysis of continuous iFR pullback measurement has previously been demonstrated to accurately predict the physiological outcome of revascularization. However, the accuracy of the online analysis approach (iFR pullback) remains untested. METHODS Angiographically intermediate tandem and/or diffuse lesions were entered into the international, multicenter iFR GRADIENT (Single instantaneous wave-Free Ratio Pullback Pre-Angioplasty Predicts Hemodynamic Outcome Without Wedge Pressure in Human Coronary Artery Disease) registry. Operators were asked to submit their procedural strategy after angiography alone and then after iFR-pullback measurement incorporating virtual PCI and post-PCI iFR prediction. PCI was performed according to standard clinical practice. Following PCI, repeat iFR assessment was performed and the actual versus predicted post-PCI iFR values compared. RESULTS Mean age was 67 ± 12 years (81% male). Paired pre- and post-PCI iFR were measured in 128 patients (134 vessels). The predicted post-PCI iFR calculated online was 0.93 ± 0.05; observed actual iFR was 0.92 ± 0.06. iFR pullback predicted the post-PCI iFR outcome with 1.4 ± 0.5% error. In comparison to angiography-based decision making, after iFR pullback, decision making was changed in 52 (31%) of vessels; with a reduction in lesion number (-0.18 ± 0.05 lesion/vessel; p = 0.0001) and length (-4.4 ± 1.0 mm/vessel; p < 0.0001). CONCLUSIONS In tandem and diffuse coronary disease, iFR pullback predicted the physiological outcome of PCI with a high degree of accuracy. Compared with angiography alone, availability of iFR pullback altered revascularization procedural planning in nearly one-third of patients.
Collapse
Affiliation(s)
- Yuetsu Kikuta
- Imperial College London and Hammersmith Hospital NHS Trust, London, United Kingdom; Fukuyama Cardiovascular Hospital, Fukuyama, Japan
| | - Christopher M Cook
- Imperial College London and Hammersmith Hospital NHS Trust, London, United Kingdom
| | - Andrew S P Sharp
- Royal Devon and Exeter Hospital and University of Exeter, Exeter, United Kingdom
| | - Pablo Salinas
- Hospital Clínico San Carlos, Faculty of Medicine, Complutense University, Madrid, Spain
| | | | - Yasutsugu Shiono
- Imperial College London and Hammersmith Hospital NHS Trust, London, United Kingdom
| | | | | | | | - Sayan Sen
- Imperial College London and Hammersmith Hospital NHS Trust, London, United Kingdom
| | - Sukhjinder S Nijjer
- Imperial College London and Hammersmith Hospital NHS Trust, London, United Kingdom
| | - Rasha Al-Lamee
- Imperial College London and Hammersmith Hospital NHS Trust, London, United Kingdom
| | - Ricardo Petraco
- Imperial College London and Hammersmith Hospital NHS Trust, London, United Kingdom
| | - Iqbal S Malik
- Imperial College London and Hammersmith Hospital NHS Trust, London, United Kingdom
| | - Ghada W Mikhail
- Imperial College London and Hammersmith Hospital NHS Trust, London, United Kingdom
| | - Raffi R Kaprielian
- Imperial College London and Hammersmith Hospital NHS Trust, London, United Kingdom
| | | | - Shinsuke Mori
- Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | | | | | | | - Farrel Hellig
- Sunninghill Hospital, Johannesburg, University of Cape Town, South Africa
| | - Kelvin Lee
- United Lincolnshire Hospital, Lincoln, United Kingdom
| | | | | | - Shah Mohdnazri
- Essex Cardiothoracic Centre, Basildon and Anglia Ruskin University, Chelmsford, Essex, United Kingdom
| | - Raul Herrera
- Hospital Clínico San Carlos, Faculty of Medicine, Complutense University, Madrid, Spain
| | | | | | - John Davies
- Essex Cardiothoracic Centre, Basildon and Anglia Ruskin University, Chelmsford, Essex, United Kingdom
| | | | - Thomas Keeble
- Essex Cardiothoracic Centre, Basildon and Anglia Ruskin University, Chelmsford, Essex, United Kingdom
| | | | | | - Ciro Indolfi
- Universita degli Studi Magna Græcia di Catanzaro, Catanzaro, Italy
| | - Jamil Mayet
- Imperial College London and Hammersmith Hospital NHS Trust, London, United Kingdom
| | - Darrel P Francis
- Imperial College London and Hammersmith Hospital NHS Trust, London, United Kingdom
| | - Jan J Piek
- Academic Medical Centre, Amsterdam, the Netherlands
| | - Carlo Di Mario
- Royal Brompton Hospital and Harefield Trust, London, United Kingdom
| | - Javier Escaned
- Hospital Clínico San Carlos, Faculty of Medicine, Complutense University, Madrid, Spain
| | | | - Justin E Davies
- Imperial College London and Hammersmith Hospital NHS Trust, London, United Kingdom.
| |
Collapse
|
34
|
Kanaji Y, Murai T, Yonetsu T, Usui E, Araki M, Matsuda J, Hoshino M, Yamaguchi M, Niida T, Hada M, Ichijyo S, Hamaya R, Kanno Y, Isobe M, Kakuta T. Effect of Elective Percutaneous Coronary Intervention on Hyperemic Absolute Coronary Blood Flow Volume and Microvascular Resistance. Circ Cardiovasc Interv 2017; 10:CIRCINTERVENTIONS.117.005073. [DOI: 10.1161/circinterventions.117.005073] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 08/23/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Yoshihisa Kanaji
- From the Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Japan (Y.K., T.M., T.Y., E.U., M.A., J.M., M.H., M.Y., T.N., M.H., S.I., R.H., Y.K., T.K.) and Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan (M.I.)
| | - Tadashi Murai
- From the Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Japan (Y.K., T.M., T.Y., E.U., M.A., J.M., M.H., M.Y., T.N., M.H., S.I., R.H., Y.K., T.K.) and Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan (M.I.)
| | - Taishi Yonetsu
- From the Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Japan (Y.K., T.M., T.Y., E.U., M.A., J.M., M.H., M.Y., T.N., M.H., S.I., R.H., Y.K., T.K.) and Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan (M.I.)
| | - Eisuke Usui
- From the Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Japan (Y.K., T.M., T.Y., E.U., M.A., J.M., M.H., M.Y., T.N., M.H., S.I., R.H., Y.K., T.K.) and Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan (M.I.)
| | - Makoto Araki
- From the Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Japan (Y.K., T.M., T.Y., E.U., M.A., J.M., M.H., M.Y., T.N., M.H., S.I., R.H., Y.K., T.K.) and Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan (M.I.)
| | - Junji Matsuda
- From the Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Japan (Y.K., T.M., T.Y., E.U., M.A., J.M., M.H., M.Y., T.N., M.H., S.I., R.H., Y.K., T.K.) and Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan (M.I.)
| | - Masahiro Hoshino
- From the Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Japan (Y.K., T.M., T.Y., E.U., M.A., J.M., M.H., M.Y., T.N., M.H., S.I., R.H., Y.K., T.K.) and Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan (M.I.)
| | - Masao Yamaguchi
- From the Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Japan (Y.K., T.M., T.Y., E.U., M.A., J.M., M.H., M.Y., T.N., M.H., S.I., R.H., Y.K., T.K.) and Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan (M.I.)
| | - Takayuki Niida
- From the Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Japan (Y.K., T.M., T.Y., E.U., M.A., J.M., M.H., M.Y., T.N., M.H., S.I., R.H., Y.K., T.K.) and Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan (M.I.)
| | - Masahiro Hada
- From the Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Japan (Y.K., T.M., T.Y., E.U., M.A., J.M., M.H., M.Y., T.N., M.H., S.I., R.H., Y.K., T.K.) and Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan (M.I.)
| | - Sadamitsu Ichijyo
- From the Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Japan (Y.K., T.M., T.Y., E.U., M.A., J.M., M.H., M.Y., T.N., M.H., S.I., R.H., Y.K., T.K.) and Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan (M.I.)
| | - Rikuta Hamaya
- From the Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Japan (Y.K., T.M., T.Y., E.U., M.A., J.M., M.H., M.Y., T.N., M.H., S.I., R.H., Y.K., T.K.) and Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan (M.I.)
| | - Yoshinori Kanno
- From the Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Japan (Y.K., T.M., T.Y., E.U., M.A., J.M., M.H., M.Y., T.N., M.H., S.I., R.H., Y.K., T.K.) and Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan (M.I.)
| | - Mitsuaki Isobe
- From the Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Japan (Y.K., T.M., T.Y., E.U., M.A., J.M., M.H., M.Y., T.N., M.H., S.I., R.H., Y.K., T.K.) and Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan (M.I.)
| | - Tsunekazu Kakuta
- From the Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Japan (Y.K., T.M., T.Y., E.U., M.A., J.M., M.H., M.Y., T.N., M.H., S.I., R.H., Y.K., T.K.) and Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan (M.I.)
| |
Collapse
|
35
|
Matsuda J, Murai T, Kanaji Y, Usui E, Araki M, Niida T, Ichijyo S, Hamaya R, Lee T, Yonetsu T, Isobe M, Kakuta T. Prevalence and Clinical Significance of Discordant Changes in Fractional and Coronary Flow Reserve After Elective Percutaneous Coronary Intervention. J Am Heart Assoc 2016; 5:e004400. [PMID: 27899365 PMCID: PMC5210426 DOI: 10.1161/jaha.116.004400] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 10/28/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND Fractional flow reserve (FFR) and coronary flow reserve (CFR) are well-validated physiological indices; however, changes in FFR and CFR after percutaneous coronary intervention (PCI) remain elusive. We sought to evaluate these changes and to investigate whether physiological indices predict cardiac event-free survival after PCI. METHODS AND RESULTS Physiological assessment of 220 stenoses from 220 patients was performed before and after PCI. The changes in FFR and CFR were studied, and factors associated with CFR change were investigated. Follow-up data were collected to determine the predictor of cardiac events. CFR increase was found in 158 (71.8%) territories, and 62 (28.2%) presented a decrease, whereas FFR increased in all 220 (100%) territories. Pre- and post-PCI percentage diameter stenoses were 57.7±11.2% and 7.48±4.79%, respectively. Post-PCI CFR increase was associated with pre-PCI indices including low FFR, low CFR and high microvascular resistance, and post-PCI hyperemic coronary flow increase. Post-PCI CFR decrease was not associated with significant post-PCI hyperemic coronary flow increase. At a median follow-up of 24.3 months, adverse event-free survival was significantly worse in patients with lower pre-PCI CFR (log-rank test λ2=7.26; P=0.007). Cox proportional hazards analysis showed that lower pre-PCI CFR (hazard ratio 0.73; 95% CI 0.55-0.97; P=0.028) was an independent predictor of adverse cardiovascular events after PCI. CONCLUSIONS CFR decrease after PCI was not uncommon, and discordant change in FFR and CFR was associated with high pre-PCI CFR, low pre-PCI microvascular resistance, and no significant post-PCI hyperemic coronary flow increase. Pre-PCI CFR, not post-PCI physiological indices, may help identify patients who require adjunctive management strategy after successful PCI.
Collapse
Affiliation(s)
- Junji Matsuda
- Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tadashi Murai
- Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan
| | - Yoshihisa Kanaji
- Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan
| | - Eisuke Usui
- Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan
| | - Makoto Araki
- Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan
| | - Takayuki Niida
- Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan
| | - Sadamitsu Ichijyo
- Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan
| | - Rikuta Hamaya
- Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan
| | - Tetsumin Lee
- Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan
| | - Taishi Yonetsu
- Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan
| | - Mitsuaki Isobe
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tsunekazu Kakuta
- Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan
| |
Collapse
|
36
|
Abstract
Adequate monitoring of patients on intensive care units is of highest priority to provide optimal treatment and to detect patients at risk. Within recent years the microcirculation became more and more attention due to its central importance for the outcome of patients. Microcirculatory disorders may include capillary flow disturbances as well as changes in the density of perfused vessels. In the clinical setting, the most often used parameter to detect alterations in the microcirculation is serum lactate. Since this parameter is characterized by major limitations, other strategies including non-invasive methods to quantify microvascular perfusion have been developed. A successful surveillance of the microcirculation in the individual patient may guide diagnostic and treatment strategies in order to optimize organ perfusion and oxygenation, subsequently leading to an individualized therapy. Intravital microscopy has been used to stratify patients at risk and to predict patients' outcome. The aim of this review is to evaluate clinical correlates of microcirculatory disorders as well as giving an overview of newer diagnostic devices that may directly or indirectly evaluate the microcirculation and are available for use in critically ill patients.
Collapse
|
37
|
Murai T, Kanaji Y, Yonetsu T, Lee T, Matsuda J, Usui E, Araki M, Niida T, Isobe M, Kakuta T. Preprocedural fractional flow reserve and microvascular resistance predict increased hyperaemic coronary flow after elective percutaneous coronary intervention. Catheter Cardiovasc Interv 2016; 89:233-242. [DOI: 10.1002/ccd.26596] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 04/30/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Tadashi Murai
- Cardiovascular Medicine; Tsuchiura Kyodo General Hospital; Tsuchiura Ibaraki Japan
| | - Yoshihisa Kanaji
- Cardiovascular Medicine; Tsuchiura Kyodo General Hospital; Tsuchiura Ibaraki Japan
| | - Taishi Yonetsu
- Cardiovascular Medicine; Tsuchiura Kyodo General Hospital; Tsuchiura Ibaraki Japan
| | - Tetsumin Lee
- Cardiovascular Medicine; Tsuchiura Kyodo General Hospital; Tsuchiura Ibaraki Japan
| | - Junji Matsuda
- Cardiovascular Medicine; Tsuchiura Kyodo General Hospital; Tsuchiura Ibaraki Japan
| | - Eisuke Usui
- Cardiovascular Medicine; Tsuchiura Kyodo General Hospital; Tsuchiura Ibaraki Japan
| | - Makoto Araki
- Cardiovascular Medicine; Tsuchiura Kyodo General Hospital; Tsuchiura Ibaraki Japan
| | - Takayuki Niida
- Cardiovascular Medicine; Tsuchiura Kyodo General Hospital; Tsuchiura Ibaraki Japan
| | - Mitsuaki Isobe
- Department of Cardiovascular Medicine; Tokyo Medical and Dental University; Tokyo Japan
| | - Tsunekazu Kakuta
- Cardiovascular Medicine; Tsuchiura Kyodo General Hospital; Tsuchiura Ibaraki Japan
| |
Collapse
|