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Zhang D, Tian X, Li MY, Zheng WS, Yu Y, Zhang HW, Pan T, Gao BL, Li CY. Quantitative computed tomography angiography evaluation of the coronary fractional flow reserve in patients with left anterior descending artery myocardial bridging. Clin Physiol Funct Imaging 2024; 44:251-259. [PMID: 38356324 DOI: 10.1111/cpf.12872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 12/28/2023] [Accepted: 01/30/2024] [Indexed: 02/16/2024]
Abstract
PURPOSE To quantitatively investigate the effect of myocardial bridge (MB) in the left anterior descending artery (LAD) on the fractional flow reserve (FFR). MATERIALS AND METHODS Three-hundred patients with LAD MB who had undergone coronary artery CT angiography (CCTA) were retrospectively enroled, and 104 normal patients were enroled as the control. The CCTA-derived fractional flow reserve (FFRCT) was measured at the LAD 10 mm proximal (FFR1) and 20-40 mm distal (FFR3) to the MB and at the MB location (FFR2). RESULTS FFR2 and FFR3 of the MB (with BM only) and MBLA (with both MB and atherosclerosis) groups were significantly (p < 0.01) lower than those of the control. The FFR3 distal to the MB was significantly lower (p < 0.01) than that of the control. The FFRCT of the whole LAD in the MBLA group was significantly (p < 0.05) lower than that of the MB and control group (p < 0.05). MB length (OR 1.061) and MB muscle index (odds ratio or OR 1.007) were two risk factors for abnormal FFRCT, and MB length was a significant independent risk factor for abnormal FFRCT (OR = 1.077). LAD stenosis degree was a risk factor for abnormal FFRCT values (OR 3.301, 95% confidence interval [CI] 1.441-7.562, p = 0.005) and was also a significant independent risk factor (OR = 3.369, 95% CI: 1.392-8.152; p = 0.007) for abnormal FFRCT. CONCLUSION MB significantly affects the FFRCT of distal coronary artery. For patients with MB without atherosclerosis, the MB length is a risk factor significantly affecting FFRCT, and for patients with MB accompanied by atherosclerosis, LAD stenotic severity is an independent risk factor for FFRCT.
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Affiliation(s)
- Dan Zhang
- Department of Radiology, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Xin Tian
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Meng-Ya Li
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Wen-Song Zheng
- Department of Radiology, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Yang Yu
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Hao-Wen Zhang
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Tong Pan
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Bu-Lang Gao
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Cai-Ying Li
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
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Aurigemma C, Ding D, Tu S, Li C, Yu W, Li Y, Leone AM, Romagnoli E, Vergallo R, Maino A, Trani C, Wijns W, Burzotta F. Three-year Clinical Impact of Murray Law-Based Quantitative Flow Ratio and OCT- or FFR-Guidance in Angiographically Intermediate Coronary Lesions. Circ Cardiovasc Interv 2024:e013191. [PMID: 38660794 DOI: 10.1161/circinterventions.123.013191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 02/14/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND The FORZA trial (FFR or OCT Guidance to Revascularize Intermediate Coronary Stenosis Using Angioplasty) prospectively compared the use of fractional flow reserve (FFR) or optical coherence tomography (OCT) for treatment decisions and percutaneous coronary intervention (PCI) optimization in patients with angiographically intermediate coronary lesions. Murray law-based quantitative-flow-ratio (μQFR) is a novel noninvasive method for the computation of FFR. In the present study, we evaluated the clinical impact of μQFR, FFR, or OCT guidance in FORZA trial lesions at 3-year follow-up. METHODS μQFR was assessed at baseline and, in the case of a decision to intervene, after (FFR- or OCT-guided) PCI. The baseline μQFR was considered the final μQFR for deferred lesions, and post-PCI μQFR value was taken as final for stented lesions. The primary end point was target vessel failure ([TVF]; cardiac death, target-vessel-related myocardial infarction, and target-vessel-revascularization) at a 3-year follow-up. RESULTS A total of 419 vessels (199 OCT-guided and 220 FFR-guided) were included in the FORZA trial. μQFR was evaluated in 256 deferred lesions and 159 treated lesions (98 OCT-guided PCI and 61 FFR-guided PCI). In treated lesions, post-PCI μQFR was higher in OCT-group compared with FFR-group (median, 0.93 versus 0.91; P=0.023), and the post-PCI μQFR improvement was greater in FFR-group (0.14 versus 0.08; P<0.0001). At 3-year follow-up, OCT- and FFR-guided treatment decisions resulted in comparable TVF rate (6.7% versus 7.9%; P=0.617). Final μQFR was the only predictor of TVF. μQFR ≤0.89 was associated with 3× increase in TVF (11.6% versus 3.7%; P=0.004). PCI was a predictor of higher final μQFR (odds ratio, 0.22 [95% CI, 0.14-0.34]; P<0.001). CONCLUSIONS In vessels with angiographically intermediate coronary lesions, OCT-guided PCI resulted in comparable clinical outcomes as FFR-guided PCI. μQFR estimated at the end of diagnostic or interventional procedure predicted 3-year TVF. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT01824030.
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Affiliation(s)
- Cristina Aurigemma
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy (C.A., E.R., R.V., C.T., F.B.)
| | - Daixin Ding
- Lambe Institute for Translational Research, Smart Sensors Laboratory and Curam, University of Galway, Ireland (D.D., W.W.)
- Department of Cardiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, China (D.D., S.T.)
| | - Shengxian Tu
- Department of Cardiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, China (D.D., S.T.)
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China (S.T., C.L., W.Y., Y.L.)
| | - Chunming Li
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China (S.T., C.L., W.Y., Y.L.)
| | - Wei Yu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China (S.T., C.L., W.Y., Y.L.)
| | - Yingguang Li
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China (S.T., C.L., W.Y., Y.L.)
| | - Antonio Maria Leone
- Ospedale Fatebenefratelli Isola Tiberina Gemelli Isola Roma, Italia (A.M.L.)
| | - Enrico Romagnoli
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy (C.A., E.R., R.V., C.T., F.B.)
| | - Rocco Vergallo
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy (C.A., E.R., R.V., C.T., F.B.)
| | - Alessandro Maino
- Università Cattolica del Sacro Cuore, Rome, Italy (A.M., C.T., F.B.)
| | - Carlo Trani
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy (C.A., E.R., R.V., C.T., F.B.)
- Università Cattolica del Sacro Cuore, Rome, Italy (A.M., C.T., F.B.)
| | - William Wijns
- Lambe Institute for Translational Research, Smart Sensors Laboratory and Curam, University of Galway, Ireland (D.D., W.W.)
| | - Francesco Burzotta
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy (C.A., E.R., R.V., C.T., F.B.)
- Università Cattolica del Sacro Cuore, Rome, Italy (A.M., C.T., F.B.)
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Burzotta F, Trani C. Coronary Physiology and Intravascular Imaging: When 2 Is Better Than 1. JACC Cardiovasc Interv 2024; 17:917-919. [PMID: 38599695 DOI: 10.1016/j.jcin.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 02/27/2024] [Accepted: 03/04/2024] [Indexed: 04/12/2024]
Affiliation(s)
- Francesco Burzotta
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Carlo Trani
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
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Fernández-Martínez D, González-Fernández MR, Nogales-Asensio JM, Ferrera C. Impact of minimal lumen segmentation uncertainty on patient-specific coronary simulations: A look at FFR CT. Int J Numer Method Biomed Eng 2024:e3822. [PMID: 38566253 DOI: 10.1002/cnm.3822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/20/2024] [Accepted: 03/24/2024] [Indexed: 04/04/2024]
Abstract
We examined the effect of minimal lumen segmentation uncertainty on Fractional Flow Reserve obtained from Coronary Computed Tomography AngiographyFFR CT $$ \left({\mathrm{FFR}}_{\mathrm{CT}}\right) $$ . A total of 14 patient-specific coronary models with different stenosis locations and degrees of severity were enrolled in this study. The optimal segmented coronary lumens were disturbed using intra± 6 % $$ \left(\pm 6\%\right) $$ and inter-operator± 15 % $$ \left(\pm 15\%\right) $$ variations on the segmentation threshold.FFR CT $$ {\mathrm{FFR}}_{\mathrm{CT}} $$ was evaluated in each case by 3D-OD CFD simulations. The findings suggest that the sensitivity ofFFR CT $$ {\mathrm{FFR}}_{\mathrm{CT}} $$ to this type of uncertainty increases distally and with the stenosis severity. Cases with moderate or severe distal coronary lesions should undergo either exact and thorough segmentation operations or invasive FFR measurements, particularly if theFFR CT $$ {\mathrm{FFR}}_{\mathrm{CT}} $$ is close to the cutoff (0.80). Therefore, we conclude that it is crucial to consider the lesion's location and degree of severity when evaluatingFFR CT $$ {\mathrm{FFR}}_{\mathrm{CT}} $$ results.
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Affiliation(s)
- Daniel Fernández-Martínez
- Departamento de Ingeniería Mecánica, Energética y de los Materiales, Universidad de Extremadura, Badajoz, Spain
| | | | | | - Conrado Ferrera
- Departamento de Ingeniería Mecánica, Energética y de los Materiales, Universidad de Extremadura, Badajoz, Spain
- Instituto de Computación Científica Avanzada, Universidad de Extremadura, Badajoz, Spain
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Choustoulakis E, Cosyns B, Sonck J, Roosens B, Pien K, Argacha JF, Lochy S, Hubloue I, de Mey J, Putman K. FFRct use for acute chest pain triage in the emergency department: a cost-effectiveness analysis. Acta Cardiol 2024; 79:167-178. [PMID: 38051089 DOI: 10.1080/00015385.2023.2285552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 11/14/2023] [Indexed: 12/07/2023]
Abstract
AIMS To model and assess the cost-effectiveness of CT-based fractional flow reserve (FFRct) for a population of low to intermediate risk patients for coronary artery disease (CAD) presenting to the emergency department (ED) with acute chest pain. METHODS AND RESULTS Using a decision tree model with a 1 year time horizon and from a health care perspective, two diagnostic pathways using FFRct are compared to current clinical routine combining coronary computed tomography angiography (CCTA) with an exercise test. Model data are drawn from the literature and nationally reported data. Outcomes are assessed as the number of avoided invasive coronary angiographies (ICAs) showing no obstructive CAD and quality of life (QoL) in a theoretical cohort of 1000 patients. Sensitivity analyses are performed to test the robustness of the results. Determining FFRct when CCTA is inconclusive is a cost-effective and dominant strategy with a potential saving of 198€/patient, 154 avoided unnecessary ICA showing no obstructive CAD (uICA)/1000 patients and an average improvement in QoL of 0.008 QALY/patient. With an additional 574€/patient, 8 avoided uICA/1000 patients and an improvement in QoL of 0.001 QALY/patient, a strategy where FFRct is always performed is cost-effective only when considering high cost-effectiveness thresholds. CONCLUSIONS For patients presenting to the ED with acute chest pain and a low to intermediate pre-test probability of CAD, a diagnostic strategy where FFRct is determined after an inconclusive CCTA is cost-effective. Clinical trials investigating both sensitivity and specificity of FFRct, as well as QoL associated with the use of this technology in this setting are warranted.
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Affiliation(s)
- Eleftherios Choustoulakis
- Department of Cardiology, Universitair Ziekenhuis Brussel, Brussels, Belgium
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Bernard Cosyns
- Department of Cardiology, Centrum voor Hart- en Vaatziekten, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Jeroen Sonck
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Advanced Biomedical Sciences, University of Naples, Federico II, Naples, Italy
| | - Bram Roosens
- Department of Cardiology, Centrum voor Hart- en Vaatziekten, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Karen Pien
- Department of Medical Registration, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Jean-François Argacha
- Department of Cardiology, Centrum voor Hart- en Vaatziekten, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Stijn Lochy
- Department of Cardiology, Centrum voor Hart- en Vaatziekten, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Ives Hubloue
- Department of Emergency Medicine, Emergency and Disaster Medicine, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Johan de Mey
- Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Koen Putman
- Department of Public Health, Faculty of Medicine and Pharmacy, Interuniversity Centre of Health Economic Research, Vrije Universiteit Brussel, Brussels, Belgium
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Ferencik M. Expanding Options for Evaluating Hemodynamic Significance of Coronary Stenosis from Computed Tomography Angiography. JACC Cardiovasc Imaging 2024:S1936-878X(24)00111-6. [PMID: 38573287 DOI: 10.1016/j.jcmg.2024.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 02/26/2024] [Indexed: 04/05/2024]
Affiliation(s)
- Maros Ferencik
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA.
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Guo Y, Yang C, Wang X, Pei Z, Zhu H, Meng X, Zhou Z, Lang X, Ning S, Zhang R, Wang F. Corrigendum: Regional myocardial work measured by echocardiography for the detection of myocardial ischemic segments: a comparative study with invasive fractional flow reserve. Front Cardiovasc Med 2024; 11:1383226. [PMID: 38529330 PMCID: PMC10962443 DOI: 10.3389/fcvm.2024.1383226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 02/21/2024] [Indexed: 03/27/2024] Open
Abstract
[This corrects the article DOI: 10.3389/fcvm.2022.813710.].
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Affiliation(s)
- Ying Guo
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Beijing, China
- Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Chenguang Yang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Beijing, China
- Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiang Wang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Beijing, China
- Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Zuowei Pei
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Beijing, China
- Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Huolan Zhu
- Department of Gerontology, Shanxi Provincial People’s Hospital, Shanxi Provincial Clinical Research Center for Geriatric Medicine, Xi’An, China
| | - Xuyang Meng
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Beijing, China
- Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Ziyu Zhou
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Beijing, China
- Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaotong Lang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Beijing, China
- Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Sun Ning
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Beijing, China
- Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Ruisheng Zhang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Beijing, China
- Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Fang Wang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Beijing, China
- Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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Abbasciano RG, Layton GR, Torre S, Abbaker N, Copperwheat A, Lucarelli C, Bhandari S, Nijjer S, Mikhail G, Casula R, Zakkar M, Viviano A. Fractional flow reserve and instantaneous wave-free ratio in coronary artery bypass grafting: a meta-analysis and practice review. Front Cardiovasc Med 2024; 11:1348341. [PMID: 38516003 PMCID: PMC10955066 DOI: 10.3389/fcvm.2024.1348341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 02/20/2024] [Indexed: 03/23/2024] Open
Abstract
Objective Fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) are invasive methods to assess the functional significance of intermediate severity coronary lesions. Both indexes have been extensively validated in clinical trials in guiding revascularisation in patients with stable ischaemic heart disease undergoing percutaneous coronary intervention (PCI) with improved clinical outcomes. However, the role of these tools in coronary artery bypass grafting (CABG) is less clear. Methods A meta-analysis of randomised trials and observational studies was carried out to help in determining the optimal strategy for assessing lesion severity and selecting graft targets in patients undergoing CABG. Electronic searches were carried out on Embase, MEDLINE, and Web of Science. A group of four authors independently screened and then assessed the retrieved records. Cochrane's Risk of Bias and Robins-I tools were used for bias assessment. A survey was conducted among surgeons and cardiologists to describe current attitudes towards the preoperative use of functional coronary investigations in practice. Results Clinical outcomes including mortality at 30 days, perioperative myocardial infarction, number of grafts, incidence of stroke, rate of further need for revascularisation, and patient-reported quality of life did not differ in CABG guided by functional testing from those guided by traditional angiography.The survey revealed that in half of the surgical and cardiology units functional assessment is performed in CABG patients; there is a general perception that functional testing has improved patient care and its use would clarify the role of moderate coronary lesions that often need multidisciplinary rediscussions; moderate stenosis are felt to be clinically relevant; and anatomical considerations need to be taken into account together with functional assessment. Conclusions At present, the evidence to support the routine use of functional testing in intermediate lesions for planning CABG is currently insufficient. The pooled data currently available do not show an increased risk in mortality, myocardial injury, and stroke in the FFR/iFR-guided group. Further trials with highly selected populations are needed to clarify the best strategy. Systematic Review Registration ClinicalTrials.gov, identifier (CRD42023414604).
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Affiliation(s)
- R. G. Abbasciano
- Department of Cardiothoracic Surgery, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - G. R. Layton
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
- Department of Cardiac Surgery, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - S. Torre
- Cardiac Surgery Unit, Giaccone Hospital, Palermo, Italy
| | - N. Abbaker
- Department of Cardiothoracic Surgery, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - A. Copperwheat
- Department of Cardiac Surgery, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - C. Lucarelli
- Department of Cardiothoracic Surgery, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - S. Bhandari
- Department of Cardiology, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - S. Nijjer
- Department of Cardiothoracic Surgery, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - G. Mikhail
- Department of Cardiothoracic Surgery, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - R. Casula
- Department of Cardiothoracic Surgery, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - M. Zakkar
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
- Department of Cardiac Surgery, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - A. Viviano
- Department of Cardiothoracic Surgery, Imperial College Healthcare NHS Trust, London, United Kingdom
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Ohashi H, Mizukami T, Sonck J, Boussiet F, Ko B, Nørgaard BL, Mæng M, Jensen JM, Sakai K, Ando H, Amano T, Amabile N, Ali Z, De Bruyne B, Koo B, Otake H, Collet C. Intravascular Imaging Findings After PCI in Patients With Focal and Diffuse Coronary Artery Disease. J Am Heart Assoc 2024; 13:e032605. [PMID: 38390822 PMCID: PMC10944036 DOI: 10.1161/jaha.123.032605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 01/17/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Following percutaneous coronary intervention (PCI), optical coherence tomography provides prognosis information. The pullback pressure gradient is a novel index that discriminates focal from diffuse coronary artery disease based on fractional flow reserve pullbacks. We sought to investigate the association between coronary artery disease patterns, defined by coronary physiology, and optical coherence tomography after stent implantation in stable patients undergoing PCI. METHODS AND RESULTS This multicenter, prospective, single-arm study was conducted in 5 countries (NCT03782688). Subjects underwent motorized fractional flow reserve pullbacks evaluation followed by optical coherence tomography-guided PCI. Post-PCI optical coherence tomography minimum stent area, stent expansion, and the presence of suboptimal findings such as incomplete stent apposition, stent edge dissection, and irregular tissue protrusion were compared between patients with focal versus diffuse disease. Overall, 102 patients (105 vessels) were included. Fractional flow reserve before PCI was 0.65±0.14, pullback pressure gradient was 0.66±0.14, and post-PCI fractional flow reserve was 0.88±0.06. The mean minimum stent area was 5.69±1.99 mm2 and was significantly larger in vessels with focal disease (6.18±2.12 mm2 versus 5.19±1.72 mm2, P=0.01). After PCI, incomplete stent apposition, stent edge dissection, and irregular tissue protrusion were observed in 27.6%, 10.5%, and 51.4% of the cases, respectively. Vessels with focal disease at baseline had a lower prevalence of incomplete stent apposition (11.3% versus 44.2%, P=0.002) and more irregular tissue protrusion (69.8% versus 32.7%, P<0.001). CONCLUSIONS Baseline coronary pathophysiological patterns are associated with suboptimal imaging findings after PCI. Patients with focal disease had larger minimum stent area and a higher incidence of tissue protrusion, whereas stent malapposition was more frequent in patients with diffuse disease.
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Affiliation(s)
- Hirofumi Ohashi
- Cardiovascular Center AalstOLV ClinicAalstBelgium
- Department of CardiologyAichi Medical UniversityAichiJapan
| | - Takuya Mizukami
- Cardiovascular Center AalstOLV ClinicAalstBelgium
- Division of Clinical Pharmacology, Department of PharmacologyShowa UniversityTokyoJapan
- Department of Cardiovascular MedicineGifu Heart CenterGifuJapan
| | - Jeroen Sonck
- Cardiovascular Center AalstOLV ClinicAalstBelgium
| | - Frederic Boussiet
- Cardiovascular Center AalstOLV ClinicAalstBelgium
- Department of CardiologyToulouse University HospitalToulouseFrance
| | - Brian Ko
- Monash Cardiovascular Research CentreMonash University and Monash Heart, Monash HealthClaytonVictoriaAustralia
| | | | - Michael Mæng
- Department of CardiologyAarhus University HospitalAarhusDenmark
| | | | - Koshiro Sakai
- Cardiovascular Center AalstOLV ClinicAalstBelgium
- Department of Medicine, Division of CardiologyShowa University School of MedicineTokyoJapan
| | - Hirohiko Ando
- Department of CardiologyAichi Medical UniversityAichiJapan
| | - Tetsuya Amano
- Department of CardiologyAichi Medical UniversityAichiJapan
| | - Nicolas Amabile
- Department of CardiologyInstitut Mutualiste MontsourisParisFrance
| | - Ziad Ali
- DeMatteis Cardiovascular InstituteSt. Francis Hospital & Heart CenterRoslynNY
| | - Bernard De Bruyne
- Cardiovascular Center AalstOLV ClinicAalstBelgium
- Department of CardiologyLausanne University HospitalLausanneSwitzerland
| | - Bon‐Kwon Koo
- Department of Internal Medicine and Cardiovascular CenterSeoul National University HospitalSeoulSouth Korea
| | - Hiromasa Otake
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
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Bendix K, Thomassen A, Junker A, Veien KT, Jensen LO. Serial fractional flow reserve, coronary flow reserve and index of microcirculatory resistance after percutaneous coronary intervention in patients treated for stable angina pectoris assessed with PET. Coron Artery Dis 2024; 35:92-98. [PMID: 38009377 PMCID: PMC10833199 DOI: 10.1097/mca.0000000000001308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/29/2023] [Indexed: 11/28/2023]
Abstract
BACKGROUND Cardiac 15 O-water PET is a noninvasive method to evaluate epicardial and microvascular dysfunction and further quantitate absolute myocardial blood flow (MBF). AIM The aim of this study was to assess the impact of revascularization on MBF and myocardial flow reserve (MFR) assessed with 15 O-water PET and invasive flow and pressure measurements. METHODS In 21 patients with single-vessel disease referred for percutaneous coronary intervention (PCI), serial PET perfusion imaging and fractional flow reserve (FFR), coronary flow reserve (CFR) and index of microcirculatory resistance (IMR) were performed during PCI and after 3 months. RESULTS In the affected myocardium, stress MBF and MFR increased significantly from before revascularization to 3 months after revascularization: stress MBF 2.4 ± 0.8 vs. 3.2 ± 0.8; P < 0.001 and MFR 2.5 ± 0.8 vs. 3.4 ± 1.1; P = 0.004. FFR and CFR increased significantly from baseline to after revascularization and remained stable from after revascularization to 3-month follow-up: FFR 0.64 ± 0.20 vs. 0.91 ± 0.06 vs. 0.91 ± 0.07; P < 0.001; CFR 2.4 ± 1.2 vs. 3.6 ± 1.9 vs. 3.6 ± 1.9; P < 0.001, whereas IMR did not change significantly: 30.3 ± 22.9 vs. 30.1 ± 25.3 vs. 31.9 ± 25.2; P = ns. After revascularization, an increase in stress MBF was associated with an increase in FFR ( r = 0.732; P < 0.001) and an increase in MFR ( r = 0.499; P = 0.021). IMR measured before PCI was inversely associated with improvement in stress MBF, ( r = -0.616; P = 0.004). CONCLUSION Recovery of myocardial perfusion after PCI was associated with an increase in FFR 3 months after revascularization. Microcirculatory dysfunction was associated with less improvement in myocardial perfusion.
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Affiliation(s)
| | | | | | | | - Lisette Okkels Jensen
- Department of Cardiology
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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11
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Yoshioka N, Shimada T, Iwasaki Y, Yoshida H, Otsuka K, Yamazaki T, Morita Y, Nakamura S, Fukuda D, Morishima I. Utility and optimal dose of nicorandil for physiological assessment of the femoropopliteal artery. Catheter Cardiovasc Interv 2024; 103:670-677. [PMID: 38363043 DOI: 10.1002/ccd.30976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 12/10/2023] [Accepted: 02/02/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Nicorandil is widely used as a vasodilator for the physiological assessment of coronary arteries because of its usefulness and safety; however, there are no data on its use in peripheral arteries. AIMS To identify the utility of nicorandil and its appropriate dose for the physiological assessment on the femoropopliteal artery. METHODS We retrospectively enrolled patients from three institutes in which physiological assessment was carried out with various doses of nicorandil before treatment. Twenty-four femoropopliteal artery stenotic lesions from 22 patients were included. The nicorandil doses used were 2, 4, and 6 mg. Twenty-two lesions were also assessed using 30 mg of papaverine. The pressure gradient (PG) and peripheral fractional flow reserve (pFFR) were calculated based on the mean and systolic pressure levels. We examined the correlation of each parameter with the peak systolic velocity ratio (PSVR) based on the duplex ultrasound images using Spearman's rank correlation coefficient. Systemic blood pressure was assessed for safety. RESULTS The correlations were higher for mean pressure-based parameters than for systolic pressure-based parameters. As the nicorandil dose increased, the correlations among PG, pFFR, and PSVR also increased (mean pressure-based PG: 2 mg, r = 0.360; 4 mg, r = 0.498; 6 mg, r = 0.694, mean pressure-based pFFR: 2 mg, r = -0.479; 4 mg, r = -0.469; 6 mg, r = -0.641). The blood pressure after the administration of 6 mg of nicorandil was low, and the median systemic mean pressure was 65 mmHg. CONCLUSION A 4 mg dose of nicorandil is effective and safe for the mean pressure-based physiological assessment of lesions in the femoropopliteal artery.
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Affiliation(s)
- Naoki Yoshioka
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Takenobu Shimada
- Department of Cardiovascular Medicine, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | | | - Hisako Yoshida
- Department of Medical Statistics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Kenichiro Otsuka
- Department of Cardiovascular Medicine, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Takanori Yamazaki
- Department of Cardiovascular Medicine, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Yasuhiro Morita
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | | | - Daiju Fukuda
- Department of Cardiovascular Medicine, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Itsuro Morishima
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
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12
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Sato Y, Motoyama S, Miyajima K, Kawai H, Sarai M, Muramatsu T, Takahashi H, Naruse H, Ahmadi A, Ozaki Y, Izawa H, Narula J. Clinical Outcomes Based on Coronary Computed Tomography-Derived Fractional Flow Reserve and Plaque Characterization. JACC Cardiovasc Imaging 2024; 17:284-297. [PMID: 37768240 DOI: 10.1016/j.jcmg.2023.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 07/17/2023] [Accepted: 07/24/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND Coronary computed tomography angiography (CTA) followed by computed tomography angiography-derived fractional flow reserve (FFRCT) is now commonly used for the management of chronic coronary syndrome (CCS). CTA-verified high-risk plaque (HRP) characteristics have also been reported to be associated with a greater likelihood of adverse cardiac events but have not been used for management decisions. OBJECTIVES The aim of this study was to evaluate clinical outcomes based on a combination of point-of-care computed tomography angiography-derived fractional flow reserve (POC-FFRCT) and the presence of HRP in CCS patients initially treated medically or with revascularization based on invasive coronary angiography findings. METHODS CTA was performed as the initial test in 5,483 patients presenting with CCS between September 2015 and December 2020 followed by invasive coronary angiography and revascularization as necessary. POC-FFRCT assessment and HRP characterization were obtained subsequently in 745 consecutive patients. We investigated how HRP and POC-FFRCT, which were not available during the original clinical decision making, correlated with the endpoint defined as a composite of cardiac death, acute coronary syndrome, and a need for unplanned revascularization. RESULTS Cardiac events occurred in 20 patients (2.7%) during a median follow-up of 744 days. The event rate was significantly higher in patients with POC-FFRCT <0.80 compared with POC-FFRCT ≥0.8 (5.4 vs 0.5 per 100 vessel years; log-rank P < 0.0001) and in patients with HRP compared to those without HRP (3.6 vs 0.8 per 100 vessel years; log-rank P = 0.0001). POC-FFRCT <0.80 and the presence of HRP were the independent predictors of cardiac events (HR: 16.67; 95% CI: 2.63-105.39; P = 0.002) compared with POC-FFRCT ≥0.8 and absent HRP. For the vessels with POC-FFRCT <0.80 and HRP, a significantly higher rate of adverse events was observed in patients who did not undergo revascularization compared with those revascularized (16.4 vs 1.4 per 100 vessel years; log-rank P = 0.006). CONCLUSIONS POC-FFRCT <0.80 and the presence of HRP were the independent predictors of cardiac events, and revascularization of HRP lesions with abnormal POC-FFRCT was associated with a lower event rate.
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Affiliation(s)
- Yoshihiro Sato
- Department of Cardiology, Fujita Health University, Aichi, Japan
| | - Sadako Motoyama
- Department of Cardiology, Fujita Health University, Aichi, Japan.
| | - Keiichi Miyajima
- Department of Cardiology, Fujita Health University, Aichi, Japan
| | - Hideki Kawai
- Department of Cardiology, Fujita Health University, Aichi, Japan
| | - Masayoshi Sarai
- Department of Cardiology, Fujita Health University, Aichi, Japan
| | | | | | - Hiroyuki Naruse
- Department of Cardiology, Fujita Health University, Aichi, Japan
| | - Amir Ahmadi
- Department of Medicine, Ichan School of Medicine at Mount Sinai, New York, New York, USA
| | - Yukio Ozaki
- Department of Cardiology, Fujita Health University, Aichi, Japan
| | - Hideo Izawa
- Department of Cardiology, Fujita Health University, Aichi, Japan
| | - Jagat Narula
- University of Texas Health Sciences Center, Houston, Texas, USA
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13
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Vira A, Balanescu DV, George JA, Dixon SR, Hanson ID, Safian RD. Diagnostic Performance of Diastolic Hyperemia-Free Ratio Compared With Invasive Fractional Flow Reserve for Evaluation of Coronary Artery Disease. Am J Cardiol 2024; 214:55-58. [PMID: 38199309 DOI: 10.1016/j.amjcard.2023.12.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/04/2023] [Accepted: 12/24/2023] [Indexed: 01/12/2024]
Abstract
Hyperemic and nonhyperemic pressure ratios are frequently used to assess the hemodynamic significance of coronary artery disease and to guide the need for myocardial revascularization. However, there are limited data on the diagnostic performance of the diastolic hyperemia-free ratio (DFR). We evaluated the diagnostic performance of the DFR compared with invasive fractional flow reserve (FFR). We performed a prospective, single-center study of 308 patients (343 lesions) who underwent DFR and FFR for evaluation of visually estimated 40% to 90% stenoses. Diagnostic performance of the DFR compared with FFR was evaluated using linear regression, Bland-Altman analysis, and receiver operating characteristic curves. The overall diagnostic accuracy of the DFR was 83%; the accuracy rates were 86%, 40%, and 95% when the DFR was <0.86, 0.88 to 0.90, and >0.93, respectively. The sensitivity, specificity, positive predicative value, and negative predictive value were 60%, 91%, 71%, and 87%, respectively. The Pearson correlation coefficient was 0.75 (p <0.05). The Bland-Altman analysis showed a mean difference of 0.09, and the area under the receiver operating characteristic curve was 0.88 (95% confidence interval 0.84 to 0.92, p <0.05). In conclusion, the DFR has a good diagnostic performance compared with FFR but 17% of the measurements were discordant. The diagnostic accuracy of the DFR was only 40% when the DFR was 0.88 to 0.90, suggesting that FFR may be useful in these arteries.
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Affiliation(s)
- Amit Vira
- Department of Cardiovascular Medicine, William Beaumont University Hospital-Corewell Health East, Royal Oak, Michigan
| | - Dinu-Valentin Balanescu
- Department of Cardiovascular Medicine, William Beaumont University Hospital-Corewell Health East, Royal Oak, Michigan
| | - Julie A George
- Department of Cardiovascular Medicine, William Beaumont University Hospital-Corewell Health East, Royal Oak, Michigan
| | - Simon R Dixon
- Department of Cardiovascular Medicine, William Beaumont University Hospital-Corewell Health East, Royal Oak, Michigan
| | - Ivan D Hanson
- Department of Cardiovascular Medicine, William Beaumont University Hospital-Corewell Health East, Royal Oak, Michigan
| | - Robert D Safian
- Department of Cardiovascular Medicine, William Beaumont University Hospital-Corewell Health East, Royal Oak, Michigan.
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14
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Choi KH, Kwon W, Shin D, Lee SH, Hwang D, Zhang J, Nam CW, Shin ES, Doh JH, Chen SL, Kakuta T, Toth GG, Piroth Z, Hakeem A, Uretsky BF, Hokama Y, Tanaka N, Lim HS, Ito T, Matsuo A, Azzalini L, Leesar MA, Daemen J, Collison D, Collet C, De Bruyne B, Koo BK, Park TK, Yang JH, Song YB, Hahn JY, Choi SH, Gwon HC, Lee JM. Differential Impact of Fractional Flow Reserve Measured After Coronary Stent Implantation by Left Ventricular Dysfunction. JACC Asia 2024; 4:229-240. [PMID: 38463680 PMCID: PMC10920040 DOI: 10.1016/j.jacasi.2023.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 10/06/2023] [Accepted: 10/18/2023] [Indexed: 03/12/2024]
Abstract
Background Both left ventricular systolic function and fractional flow reserve (FFR) are prognostic factors after percutaneous coronary intervention (PCI). However, how these prognostic factors are inter-related in risk stratification of patients after PCI remains unclarified. Objectives This study evaluated differential prognostic implication of post-PCI FFR according to left ventricular ejection fraction (LVEF). Methods A total of 2,965 patients with available LVEF were selected from the POST-PCI FLOW (Prognostic Implications of Physiologic Investigation After Revascularization with Stent) international registry of patients with post-PCI FFR measurement. The primary outcome was a composite of cardiac death or target-vessel myocardial infarction (TVMI) at 2 years. The secondary outcome was target-vessel revascularization (TVR) and target vessel failure, which was a composite of cardiac death, TVMI, or TVR. Results Post-PCI FFR was independently associated with the risk of target vessel failure (per 0.01 decrease: HRadj: 1.029; 95% CI: 1.009-1.049; P = 0.005). Post-PCI FFR was associated with increased risk of cardiac death or TVMI (HRadj: 1.145; 95% CI: 1.025-1.280; P = 0.017) among patients with LVEF ≤40%, and with that of TVR in patients with LVEF >40% (HRadj: 1.028; 95% CI: 1.005-1.052; P = 0.020). Post-PCI FFR ≤0.80 was associated with increased risk of cardiac death or TVMI in the LVEF ≤40% group and with that of TVR in LVEF >40% group. Prognostic impact of post-PCI FFR for the primary outcome was significantly different according to LVEF (Pinteraction = 0.019). Conclusions Post-PCI FFR had differential prognostic impact according to LVEF. Residual ischemia by post-PCI FFR ≤0.80 was a prognostic indicator for cardiac death or TVMI among patients with patients with LVEF ≤40%, and it was associated with TVR among patients with patients with LVEF>40%. (Prognostic Implications of Physiologic Investigation After Revascularization with Stent [POST-PCI FLOW]; NCT04684043).
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Affiliation(s)
- Ki Hong Choi
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Woochan Kwon
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Doosup Shin
- Division of Cardiology, Department of Internal Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Seung-Hun Lee
- Division of Cardiology, Department of Internal Medicine, Heart Center, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Doyeon Hwang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Jinlong Zhang
- Department of Cardiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Chang-Wook Nam
- Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Eun-Seok Shin
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Joon-Hyung Doh
- Department of Medicine, Inje University Ilsan-Paik Hospital, Goyang, Korea
| | - Shao-Liang Chen
- Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Tsunekazu Kakuta
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Gabor G. Toth
- University Heart Centre Graz, Medical University Graz, Austria
| | - Zsolt Piroth
- Gottsegen National Cardiovascular Centre, Budapest, Hungary
| | - Abdul Hakeem
- Division of Cardiovascular Diseases and Hypertension, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, USA
| | - Barry F. Uretsky
- Central Arkansas VA Health System/University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Yohei Hokama
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Nobuhiro Tanaka
- Department of Cardiology, Ajou University School of Medicine, Suwon, Korea
| | - Hong-Seok Lim
- Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Tsuyoshi Ito
- Department of Cardiology, Kyoto Second Red Cross Hospital, Kyoto, Japan
| | - Akiko Matsuo
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Lorenzo Azzalini
- Division of Cardiovascular Diseases, University of Alabama, Birmingham, Alabama, USA
| | - Massoud A. Leesar
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Joost Daemen
- West of Scotland Regional Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom
| | | | - Carlos Collet
- Department of Cardiology, University of Lausanne, Switzerland
| | | | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Taek Kyu Park
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Hoon Yang
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Bin Song
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joo-Yong Hahn
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung-Hyuk Choi
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyeon-Cheol Gwon
- 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
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Wong CC, Yong AS. Quantitative Flow Ratio-Guided Revascularization: Equally Effective Between the Sexes. JACC Asia 2024; 4:213-215. [PMID: 38463682 PMCID: PMC10920045 DOI: 10.1016/j.jacasi.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Affiliation(s)
- Christopher C.Y. Wong
- Department of Cardiology, Concord Repatriation General Hospital, Concord, New South Wales, Australia
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Andy S.C. Yong
- Department of Cardiology, Concord Repatriation General Hospital, Concord, New South Wales, Australia
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Sykes R, Hanna R, Berry C. Prognostic Importance of Fractional Flow Reserve and Left Ventricular Systolic Dysfunction After Percutaneous Coronary Intervention. JACC Asia 2024; 4:241-243. [PMID: 38463675 PMCID: PMC10920047 DOI: 10.1016/j.jacasi.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Affiliation(s)
- Robert Sykes
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom
- West of Scotland Heart and Lung Center, Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - Rebecca Hanna
- NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Colin Berry
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom
- West of Scotland Heart and Lung Center, Golden Jubilee National Hospital, Glasgow, United Kingdom
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Warisawa T, Akasaka T. Imaging-Based FFR: How Many Steps Toward Replacement for Wire-Based FFR on A Journey of A Thousand Miles. Circ Cardiovasc Imaging 2024; 17:e016700. [PMID: 38502738 DOI: 10.1161/circimaging.124.016700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Affiliation(s)
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Nishinomiya Watanabe Cardiovascular Cerebral Center, Japan (T.A.)
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Li SY, Zhong J, Qiao HY, Schoepf UJ, Emrich T, Butler WN, Zuo R, Xue Y, Liu Y, Dai LY, Zhou CS, Lu GM, Tang CX, Zhang LJ. FFR CT and Static Computed Tomography Myocardial Perfusion Imaging for Therapeutic Decision-making and Prognosis in Patients With Coronary Artery Disease. J Thorac Imaging 2024; 39:101-110. [PMID: 37265250 PMCID: PMC10878454 DOI: 10.1097/rti.0000000000000718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE The purpose of this study was to investigate the effect of integrated evaluation of resting static computed tomography perfusion (CTP) and coronary computed tomography angiography (CCTA)-derived fractional flow reserve (FFR CT ) on therapeutic decision-making and predicting major adverse cardiovascular events (MACEs) in patients with suspected coronary artery disease. MATERIALS AND METHODS In this post hoc analysis of a prospective trial of CCTA in patients assigned to either CCTA or CCTA plus FFR CT arms, 500 patients in the CCTA plus FFR CT arm were analyzed. Both resting static CTP and FFR CT were evaluated by using the conventional CCTA. Perfusion defects in the myocardial segments with ≥50% degree of stenosis in the supplying vessels were defined as resting static CTP positive, and any vessel with an FFR CT value of ≤0.80 was considered positive. Patients were divided into 3 groups: (1) negative CTP-FFR CT match group (resting static CTP-negative and FFR CT -negative group); (2) mismatch CTP-FFR CT group (resting static CTP-positive and FFR CT -negative or resting static CTP-negative and FFR CT -positive group); and (3) positive CTP-FFR CT match group (resting static CTP-positive and FFR CT -positive group). We compared the revascularization-to-invasive coronary angiography ratio and the MACE rate among 3 subgroups at 1- and 3-year follow-ups. The adjusted Cox hazard proportional model was used to assess the prognostic value of FFR CT and resting static CTP to determine patients at risk of MACE. RESULTS Patients in the positive CTP-FFR CT match group were more likely to undergo revascularization at the time of invasive coronary angiography compared with those in the mismatch CTP-FFR CT group (81.4% vs 57.7%, P =0.033) and the negative CTP-FFR CT match group (81.4% vs 33.3%, P= 0.001). At 1- and 3-year follow-ups, patients in the positive CTP-FFR CT match group were more likely to have MACE than those in the mismatch CTP-FFR CT group (10.5% vs 4.2%, P= 0.046; 35.6% vs 9.4%, P <0.001) and the negative CTP-FFR CT match group (10.5% vs 0.9%, P <0.001; 35.6% vs 5.4%, P <0.001). A positive CTP-FFR CT match was strongly related to MACE at 1-year (hazard ratio=8.06, P= 0.003) and 3-year (hazard ratio=6.23, P <0.001) follow-ups. CONCLUSION In patients with suspected coronary artery disease, the combination of FFR CT with resting static CTP could guide therapeutic decisions and have a better prognosis with fewer MACE in a real-world scenario.
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Affiliation(s)
- Su Yu Li
- Department of Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing
| | - Jian Zhong
- Department of Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing
| | - Hong Yan Qiao
- Department of Medical Imaging, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu Province, China
| | - U. Joseph Schoepf
- Department of Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC
| | - Tilman Emrich
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC
| | - W. Nicholas Butler
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC
| | - Rui Zuo
- Department of Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing
| | - Yi Xue
- Department of Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing
| | - Ya Liu
- Department of Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing
| | - Li Yan Dai
- Department of Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing
| | - Chang Sheng Zhou
- Department of Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing
| | - Guang Ming Lu
- Department of Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing
| | - Chun Xiang Tang
- Department of Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing
| | - Long Jiang Zhang
- Department of Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing
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Warisawa T, Matsumoto T, Katsura A, Ando J. Distal Coronary Flow Assessment During Perfusion Balloon Occlusion in Left Main Coronary Artery in Humans. JACC Cardiovasc Interv 2024:S1936-8798(24)00406-0. [PMID: 38573251 DOI: 10.1016/j.jcin.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 02/06/2024] [Indexed: 04/05/2024]
Affiliation(s)
| | - Takuya Matsumoto
- Department of Cardiology, NTT Medical Center Tokyo, Tokyo, Japan
| | - Aritomo Katsura
- Department of Cardiology, NTT Medical Center Tokyo, Tokyo, Japan
| | - Jiro Ando
- Department of Cardiology, NTT Medical Center Tokyo, Tokyo, Japan
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Kanoun Schnur SS, Pranevičius R, Stark C, Prunea D, Andreka J, Schmidt A, Harb S, Ruzsa Z, Zweiker R, Kane J, Toth GG. Operator decision-making in angiography-only guided revascularization for lesions not indicated for FFR: a QFR-based functional assessment in chronic coronary syndrome. Front Cardiovasc Med 2024; 11:1336341. [PMID: 38468724 PMCID: PMC10925875 DOI: 10.3389/fcvm.2024.1336341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 02/13/2024] [Indexed: 03/13/2024] Open
Abstract
Background Discordance between coronary angiographic findings and invasive functional significance is well-established. Yet, the prevalence of this mismatch in an era increasingly utilizing invasive functional assessments, such as fractional flow reserve (FFR), remains unclear. This study examines the extent of such discrepancies in current clinical practice. Methods This single-center prospective registry included consecutive patients with chronic coronary syndrome (CCS) who underwent elective coronary angiography, with or without revascularization. Coronary angiograms deemed not requiring FFR due to clear anatomical distinctions, either anatomically severe indicating a need for revascularization or mild suggesting no need for intervention, were selected for evaluation. These were then subjected to post-hoc analysis by three independent operators who were blinded to the definitive treatment strategies. Importantly, the post-hoc analysis was conducted in two distinct phases: firstly, a re-evaluation of coronary stenosis, and secondly, a separate functional assessment, each carried out independently. Coronary stenosis severity was assessed visually, while functional relevance was determined by quantitative flow ratio (QFR), calculated using a computational fluid dynamics algorithm applied to angiographic images. Analysis focused on discrepancies between QFR-based functional indications and revascularization strategies actually performed. Results In 191 patients, 488 vessels were analyzed. Average diameter stenosis (DS) was 37 ± 34%, and QFR was 0.87 ± 0.15, demonstrating a moderate correlation (r = -0.84; 95% CI: -0.86 to -0.81, p < 0.01). Agreement with QFR at conventional anatomical cutoffs was 88% for 50% DS and 91% for 70% DS. Mismatches between revascularization decisions and QFR indications occurred in 10% of cases. Discrepancies were more frequent in the left anterior descending artery (14%) compared to the left circumflex (6%) and the right coronary artery (9%; p = 0.07). Conclusion In a cardiac-center where FFR utilization is high, discordance between coronary angiography and functional significance persists, even when operators are confident in their decisions not to use functional interrogation. This gap, most evident in the left anterior descending artery, highlights the potential need for integrated angiography-based functional assessments to refine revascularization decisions in CCS.
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Affiliation(s)
- Sadeek S. Kanoun Schnur
- Department of Cardiology, UniversityHeart Center Graz, Medical University Graz, Graz, Austria
- Peninsula Deanery, Royal Devon University Healthcare NHS Foundation Trust, Exeter, United Kingdom
- Doctoral School of Clinical Medicine, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Robertas Pranevičius
- Department of Cardiology, UniversityHeart Center Graz, Medical University Graz, Graz, Austria
- Department of Cardiology, Heart and Vascular Center, Republican Siauliai Hospital, Siauliai, Lithuania
| | - Cosima Stark
- Department of Cardiology, UniversityHeart Center Graz, Medical University Graz, Graz, Austria
| | - Dan Prunea
- Department of Cardiology, UniversityHeart Center Graz, Medical University Graz, Graz, Austria
- “Niculae Stancioiu” Heart Institute, University of Medicine “Iuliu Hatieganu”, Cluj-Napoca, Romania
| | - Judit Andreka
- Department of Cardiology, UniversityHeart Center Graz, Medical University Graz, Graz, Austria
- Doctoral School of Clinical Medicine, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Albrecht Schmidt
- Department of Cardiology, UniversityHeart Center Graz, Medical University Graz, Graz, Austria
| | - Stefan Harb
- Department of Cardiology, UniversityHeart Center Graz, Medical University Graz, Graz, Austria
| | - Zoltan Ruzsa
- Doctoral School of Clinical Medicine, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Robert Zweiker
- Department of Cardiology, UniversityHeart Center Graz, Medical University Graz, Graz, Austria
| | - Jesse Kane
- Department of Cardiology, University of Vermont Larner College of Medicine, Burlington, VT, United States
| | - Gabor G. Toth
- Department of Cardiology, UniversityHeart Center Graz, Medical University Graz, Graz, Austria
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21
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Johnson NP, Gould KL, Narula J. Should We Stent Vulnerable, But Asymptomatic, Lesions? JACC Cardiovasc Interv 2024; 17:471-473. [PMID: 38340101 DOI: 10.1016/j.jcin.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 12/12/2023] [Indexed: 02/12/2024]
Affiliation(s)
- Nils P Johnson
- Weatherhead P.E.T. Imaging Center for Preventing and Reversing Atherosclerosis, Houston, Texas, USA; Division of Cardiology, Department of Medicine, McGovern Medical School at UTHealth, Houston, Texas, USA.
| | - K Lance Gould
- Weatherhead P.E.T. Imaging Center for Preventing and Reversing Atherosclerosis, Houston, Texas, USA; Division of Cardiology, Department of Medicine, McGovern Medical School at UTHealth, Houston, Texas, USA
| | - Jagat Narula
- Division of Cardiology, Department of Medicine, McGovern Medical School at UTHealth, Houston, Texas, USA
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22
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Campo Dall'Orto C, Eurípedes Vilela L, Vilella Pinto Filho G, Raphael da Silva M. Impact of Sex Differences on the Outcomes of Coronary Invasive Physiological Assessment: Long-Term Follow-Up in a Brazilian Population. Womens Health Rep (New Rochelle) 2024; 5:93-103. [PMID: 38404671 PMCID: PMC10890956 DOI: 10.1089/whr.2023.0087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/10/2023] [Indexed: 02/27/2024]
Abstract
Objective This study aimed to evaluate the rate of major adverse cardiac events (MACEs; the sum of death, myocardial infarction, and revascularization rates) according to interventional strategies guided by invasive physiological methods in both sexes in a Brazilian population during long-term follow-up for an average of 2 years. Methods This retrospective single-center study included 151 consecutive patients (232 lesions) between January 2018 and January 2022. The participants were divided into two groups: the female group (FG), comprising 59 patients with 88 lesions, and the male group (MG), comprising 92 patients with 144 lesions. Results The FG had a greater mean age (FG: 67.96 ± 13.12 vs. MG: 62.36 ± 12.01 years, p = 0.009) and lower mean creatinine clearance (FG: 79.35 ± 38.63 vs. MG: 92.02 ± 38.62 mL/min, p = 0.02) than did the MG. The percentage of lesions in the left main coronary artery was higher in the FG than in the MG (12.5% vs. 2.78%, p = 0.006). The mean follow-up time was longer in the MG than in the FG (795.61 ± 350 vs. 619.19 ± 318 days, respectively; p = 0.001). MACE occurred in 11.86% and 13.04% of patients in the FG and MG, respectively (p = 0.850). Secondary outcomes, such as death, reinfarction, and the need for new revascularization, showed no significant between-sex differences. Conclusions Our study demonstrated the safety of invasive physiological methods to determine coronary revascularization in both male and female patients in a Brazilian population, as evidenced by the low rates of adverse cardiac events and death after a long-term follow-up.
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Affiliation(s)
- Clarissa Campo Dall'Orto
- Department of Hemodynamic and Interventional Cardiology, Advanced Hemodynamic Therapy Center, Brazilian Society of Health Support Hospital, Teixeira de Freitas, Bahia, Brazil
| | - Lara Eurípedes Vilela
- Department of Hemodynamic and Interventional Cardiology, Advanced Hemodynamic Therapy Center, Brazilian Society of Health Support Hospital, Teixeira de Freitas, Bahia, Brazil
| | - Gilvan Vilella Pinto Filho
- Department of Hemodynamic and Interventional Cardiology, Advanced Hemodynamic Therapy Center, Brazilian Society of Health Support Hospital, Teixeira de Freitas, Bahia, Brazil
| | - Marcos Raphael da Silva
- Department of Hemodynamic and Interventional Cardiology, Advanced Hemodynamic Therapy Center, Brazilian Society of Health Support Hospital, Teixeira de Freitas, Bahia, Brazil
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23
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Boeckling F, Stähli BE, Rudolph T, Lutz M, Schatz AS, Vogelmann T, Stueve M, West NEJ, Boone E, Erbay A, Leistner DM. Fractional flow reserve measurements and long-term mortality-results from the FLORIDA study. Front Cardiovasc Med 2024; 11:1337941. [PMID: 38404721 PMCID: PMC10885355 DOI: 10.3389/fcvm.2024.1337941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/29/2024] [Indexed: 02/27/2024] Open
Abstract
Background Randomized evidence suggested improved outcomes in fractional flow reserve (FFR) guidance of coronary revascularization compared to medical therapy in well-defined patient cohorts. However, the impact of FFR-guided revascularization on long-term outcomes of unselected patients with chronic or acute coronary syndromes (ACS) is unknown. Aims The FLORIDA (Fractional FLOw Reserve In cardiovascular DiseAses) study sought to investigate outcomes of FFR-guided vs. angiography-guided treatment strategies in a large, real-world cohort. Methods This study included patients enrolled into the German InGef Research Database. Patients undergoing coronary angiography between January 2014 and December 2015 were included in the analysis. Eligible patients had at least one inpatient coronary angiogram for suspected coronary artery disease between January 2014 and December 2015. Patients were stratified into FFR arm if a coronary angiography with adjunctive FFR measurement was performed, otherwise into the angiography-only arm. Matching was applied to ensure a balanced distribution of baseline characteristics in the study cohort. Patients were followed for 3 years after index date and primary endpoint was all-cause mortality. Results In the matched population, mortality at 3 years was 9.6% in the FFR-assessed group and 12.6% in the angiography-only group (p = 0.002), corresponding to a 24% relative risk reduction with use of FFR. This effect was most pronounced in patients in whom revascularization was deferred based on FFR (8.7% vs. 12.3%, p = 0.04) and in high-risk subgroups including patients aged ≥75 years (14.9% vs. 20.1%, p < 0.01) and those presenting with ACS (10.2% vs. 14.0%, p = 0.04). Conclusions FFR-based revascularization strategy was associated with reduced mortality at 3 years. These findings further support the use of FFR in everyday clinical practice.
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Affiliation(s)
- Felicitas Boeckling
- Department of Medicine, Cardiology, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Barbara E. Stähli
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Tanja Rudolph
- Department for General and Interventional Cardiology/Angiology, Heart- und Diabetes Center NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Matthias Lutz
- Department of Cardiology and Angiology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Anne-Sophie Schatz
- Department of Cardiology, Charité—University Medicine Berlin, Berlin, Germany
| | | | | | | | - Els Boone
- Abbott Vascular, Santa Clara, CA, United States
| | - Aslihan Erbay
- Department of Medicine, Cardiology, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - David M. Leistner
- Department of Medicine, Cardiology, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
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24
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Minten L, Dubois C, Desmet W, Bennett J. Economical aspects of coronary angiography for diagnostic purposes: a Belgian perspective. Acta Cardiol 2024; 79:41-45. [PMID: 37962299 DOI: 10.1080/00015385.2023.2281105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 11/03/2023] [Indexed: 11/15/2023]
Abstract
Coronary angiography (CA) is an increasing diagnostic procedure in Belgium. The aim of this analysis was to look at the financial aspects of CA in a large tertiary Belgium hospital to establish if current reimbursement is appropriate. For the analysis of costs we considered the use of the catheterisation laboratory, personnel costs and material costs during multiple weekly periods in the spring of 2023. We calculated that one cathlab needs to perform 8.21 CA's to equal incomes with costs. To allow for a small positive income (200€) for the hospital/cardiologist 9 procedures per cathlab day are required. Our hospital performs a 7 (mean) ± 0.75 (standard deviation) of CA's per cathlab day and therefore does not reach this financial break-even point. Our calculations are on the safe side, since coronary physiological interrogation with fractional flow reserve (FFR) was excluded from this analysis. Nevertheless, this is a cost-effective technique for which no extra reimbursement is foreseen in the current Belgium system.
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Affiliation(s)
- Lennert Minten
- Department of Cardiovascular Sciences, Kaholieke Universiteit Leuven, Leuven, Belgium
- Department of Cardiovascular Medicine, University Hospitals Leuven (UZ Leuven), Leuven Belgium
| | - Christophe Dubois
- Department of Cardiovascular Sciences, Kaholieke Universiteit Leuven, Leuven, Belgium
- Department of Cardiovascular Medicine, University Hospitals Leuven (UZ Leuven), Leuven Belgium
| | - Walter Desmet
- Department of Cardiovascular Sciences, Kaholieke Universiteit Leuven, Leuven, Belgium
- Department of Cardiovascular Medicine, University Hospitals Leuven (UZ Leuven), Leuven Belgium
| | - Johan Bennett
- Department of Cardiovascular Sciences, Kaholieke Universiteit Leuven, Leuven, Belgium
- Department of Cardiovascular Medicine, University Hospitals Leuven (UZ Leuven), Leuven Belgium
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25
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de Winter RW, van Diemen PA, Schumacher SP, Jukema RA, Somsen YBO, Hoek R, van Rossum AC, Twisk JWR, de Waard GA, Nap A, Raijmakers PG, Driessen RS, Knaapen P, Danad I. Hemodynamic Insights into Combined Fractional Flow Reserve and Instantaneous Wave-Free Ratio Assessment Through Quantitative [ 15O]H 2O PET Myocardial Perfusion Imaging. J Nucl Med 2024; 65:279-286. [PMID: 38176722 DOI: 10.2967/jnumed.123.265973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 11/01/2023] [Indexed: 01/06/2024] Open
Abstract
In patients evaluated for obstructive coronary artery disease (CAD), guidelines recommend using either fractional flow reserve (FFR) or instantaneous wave-free ratio (iFR) to guide coronary revascularization decision-making. The hemodynamic significance of lesions with discordant FFR and iFR measurements is debated. This study compared [15O]H2O PET-derived absolute myocardial perfusion between vessels with concordant and discordant FFR and iFR measurements. Methods: We included 197 patients suspected of obstructive CAD who had undergone [15O]H2O PET perfusion imaging and combined FFR/iFR interrogation in 468 vessels. Resting myocardial blood flow (MBF), hyperemic MBF, and coronary flow reserve (CFR) were compared among 4 groups: FFR low/iFR low (n = 79), FFR high/iFR low (n = 22), FFR low/iFR high (n = 22), and FFR high/iFR high (n = 345). Predefined [15O]H2O PET thresholds for ischemia were 2.3 mL·min-1·g-1 or less for hyperemic MBF and 2.5 or less for CFR. Results: Hyperemic MBF was lower in the concordant low (2.09 ± 0.67 mL·min-1·g-1), FFR high/iFR low (2.41 ± 0.80 mL·min-1·g-1), and FFR low/iFR high (2.40 ± 0.69 mL·min-1·g-1) groups compared with the concordant high group (2.91 ± 0.84 mL·min-1·g-1) (P < 0.001, P = 0.004, and P < 0.001, respectively). A lower CFR was observed in the concordant low (2.37 ± 0.76) and FFR high/iFR low (2.64 ± 0.84) groups compared with the concordant high group (3.35 ± 1.07, P < 0.01 for both). However, for vessels with either low FFR or low iFR, quantitative hyperemic MBF and CFR values exceeded the ischemic threshold in 38% and 49%, respectively. In addition, resting MBF exhibited a negative correlation with iFR (P < 0.001) and was associated with FFR low/iFR high discordance compared with concordant low FFR/low iFR measurements, independent of clinical and angiographic characteristics, as well as hyperemic MBF (odds ratio [OR], 0.41; 95% CI, 0.26-0.65; P < 0.001). Conclusion: We found reduced myocardial perfusion in vessels with concordant low and discordant FFR/iFR measurements. However, FFR/iFR combinations often inaccurately classified vessels as either ischemic or nonischemic when compared with hyperemic MBF and CFR. Furthermore, a lower resting MBF was associated with a higher iFR and the occurrence of FFR low/iFR high discordance. Our study showed that although combined FFR/iFR assessment can be useful to estimate the hemodynamic significance of coronary lesions, these pressure-derived indices provide a limited approximation of [15O]H2O PET-derived quantitative myocardial perfusion as the physiologic standard of CAD severity.
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Affiliation(s)
- Ruben W de Winter
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Pepijn A van Diemen
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Stefan P Schumacher
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ruurt A Jukema
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Yvemarie B O Somsen
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Roel Hoek
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Albert C van Rossum
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jos W R Twisk
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; and
| | - Guus A de Waard
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Alexander Nap
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Pieter G Raijmakers
- Department of Radiology, Nuclear Medicine, and PET Research, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Roel S Driessen
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Paul Knaapen
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands;
| | - Ibrahim Danad
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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26
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Biscaglia S, Verardi FM, Erriquez A, Colaiori I, Cocco M, Cantone A, Pompei G, Marrone A, Caglioni S, Tumscitz C, Penzo C, Manfrini M, Leone AM, Versaci F, Campo G. Coronary Physiology Guidance vs Conventional Angiography for Optimization of Percutaneous Coronary Intervention: The AQVA-II Trial. JACC Cardiovasc Interv 2024; 17:277-287. [PMID: 37902150 DOI: 10.1016/j.jcin.2023.10.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/10/2023] [Accepted: 10/12/2023] [Indexed: 10/31/2023]
Abstract
BACKGROUND The debate surrounding the efficacy of coronary physiological guidance compared with conventional angiography in achieving optimal post-percutaneous coronary intervention (PCI) fractional flow reserve (FFR) values persists. OBJECTIVES The primary aim of this study was to demonstrate the superiority of physiology-guided PCI, using either angiography or microcatheter-derived FFR, over conventional angiography-based PCI in complex high-risk indicated procedures (CHIPs). The secondary aim was to establish the noninferiority of angiography-derived FFR guidance compared with microcatheter-derived FFR guidance. METHODS Patients with obstructive coronary lesions and meeting CHIP criteria were randomized 2:1 to receive undergo physiology- or angiography-based PCI. Those assigned to the former were randomly allocated to angiography- or microcatheter-derived FFR guidance. CHIP criteria were long lesion (>28 mm), tandem lesions, severe calcifications, severe tortuosity, true bifurcation, in-stent restenosis, and left main stem disease. The primary outcome was invasive post-PCI FFR value. The optimal post-PCI FFR value was defined as >0.86. RESULTS A total of 305 patients (331 study vessels) were enrolled in the study (101 undergoing conventional angiography-based PCI and 204 physiology-based PCI). Optimal post-PCI FFR values were more frequent in the physiology-based PCI group compared with the conventional angiography-based PCI group (77% vs 54%; absolute difference 23%, relative difference 30%; P < 0.0001). The occurrence of the primary outcome did not differ between the 2 physiology-based PCI subgroups, demonstrating the noninferiority of angiography- vs microcatheter-derived FFR (P < 0.01). CONCLUSIONS In CHIP patients, procedural planning and guidance on the basis of physiology (through either angiography- or microcatheter-derived FFR) are superior to conventional angiography for achieving optimal post-PCI FFR values. (Physiology Optimized Versus Angio-Guided PCI [AQVA-II]; NCT05658952).
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Affiliation(s)
- Simone Biscaglia
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona, Italy.
| | | | - Andrea Erriquez
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona, Italy
| | - Iginio Colaiori
- UOC UTIC Emodinamica e Cardiologia, Ospedale Santa Maria Goretti, Latina, Italy
| | - Marta Cocco
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona, Italy
| | - Anna Cantone
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona, Italy
| | - Graziella Pompei
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona, Italy
| | - Andrea Marrone
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona, Italy
| | - Serena Caglioni
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona, Italy
| | - Carlo Tumscitz
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona, Italy
| | - Carlo Penzo
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona, Italy
| | - Marco Manfrini
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Antonio Maria Leone
- Center of Excellence in Cardiovascular Sciences, Ospedale Fatebenefratelli Isola Tiberina, Gemelli Isola, Rome, Italy
| | - Francesco Versaci
- UOC UTIC Emodinamica e Cardiologia, Ospedale Santa Maria Goretti, Latina, Italy
| | - Gianluca Campo
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona, Italy
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27
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Barrera S, de la Torre Hernández JM. Coronary Physiology by Different Approaches to Guide PCI: Adding Allies to Optimize Outcomes. JACC Cardiovasc Interv 2024; 17:288-291. [PMID: 38267143 DOI: 10.1016/j.jcin.2023.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 11/03/2023] [Accepted: 11/13/2023] [Indexed: 01/26/2024]
Affiliation(s)
- Sergio Barrera
- Hospital Universitario Marques de Valdecilla, Servicio de Cardiología, Unidad de Cardiología Intervencionista, IDIVAL, Santander, Spain
| | - José M de la Torre Hernández
- Hospital Universitario Marques de Valdecilla, Servicio de Cardiología, Unidad de Cardiología Intervencionista, IDIVAL, Santander, Spain.
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28
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Yang S, Wang Z, Park SH, Hong H, Li C, Liu X, Chen L, Hwang D, Zhang J, Hoshino M, Yonetsu T, Shin ES, Doh JH, Nam CW, Wang J, Chen S, Tanaka N, Matsuo H, Kubo T, Chang HJ, Kakuta T, Koo BK, Tu S. Relationship of Coronary Angiography-Derived Radial Wall Strain With Functional Significance, Plaque Morphology, and Clinical Outcomes. JACC Cardiovasc Interv 2024; 17:46-56. [PMID: 38199753 DOI: 10.1016/j.jcin.2023.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 09/14/2023] [Accepted: 10/03/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Coronary angiography-derived radial wall strain (RWS) is a newly developed index that can be readily accessed and describes the biomechanical features of a lesion. OBJECTIVES The authors sought to investigate the association of RWS with fractional flow reserve (FFR) and high-risk plaque (HRP), and their relative prognostic implications. METHODS We included 484 vessels (351 patients) deferred after FFR measurement with available RWS data and coronary computed tomography angiography. On coronary computed tomography angiography, HRP was defined as a lesion with both minimum lumen area <4 mm2 and plaque burden ≥70%. The primary outcome was target vessel failure (TVF), a composite of target vessel revascularization, target vessel myocardial infarction, or cardiac death. RESULTS The mean FFR and RWSmax were 0.89 ± 0.07 and 11.2% ± 2.5%, respectively, whereas 27.7% of lesions had HRP, 15.1% had FFR ≤0.80. An increase in RWSmax was associated with a higher risk of FFR ≤0.80 and HRP, which was consistent after adjustment for clinical or angiographic characteristics (all P < 0.05). An increment of RWSmax was related to a higher risk of TVF (HR: 1.23 [95% CI: 1.03-1.47]; P = 0.022) with an optimal cutoff of 14.25%. RWSmax >14% was a predictor of TVF after adjustment for FFR or HRP components (all P < 0.05) and showed a direct prognostic effect on TVF, not mediated by FFR ≤0.80 or HRP in the mediation analysis. When high RWSmax was added to FFR ≤0.80 or HRP, there were increasing outcome trends (all P for trend <0.001). CONCLUSIONS RWS was associated with coronary physiology and plaque morphology but showed independent prognostic significance.
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Affiliation(s)
- Seokhun Yang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Zhiqing Wang
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China; Department of Cardiology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Sang-Hyeon Park
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Huihong Hong
- Department of Cardiology, the First Hospital of Quanzhou Affiliated to Fujian Medical University, Quanzhou, China
| | - Chunming Li
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Xun Liu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Lianglong Chen
- Department of Cardiology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Doyeon Hwang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Jinlong Zhang
- Department of Cardiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Masahiro Hoshino
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Taishi Yonetsu
- Department of Interventional Cardiology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Eun-Seok Shin
- Department of Cardiology, Ulsan University Hospital, Ulsan, Korea
| | - Joon-Hyung Doh
- Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Chang-Wook Nam
- Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Jianan Wang
- Department of Cardiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Shaoliang Chen
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Nobuhiro Tanaka
- Department of Cardiology, Tokyo Medical University, Tokyo, Japan
| | | | - Takashi Kubo
- Department of Cardiology, Tokyo Medical University, Hachioji Medical Center, Tokyo, Japan
| | - Hyuk-Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Seoul, Korea
| | - Tsunekazu Kakuta
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea.
| | - Shengxian Tu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China.
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Rasmussen LD, Gormsen LC, Ejlersen JA, Karim SR, Westra J, Knudsen LL, Kirk J, Søndergaard HM, Mortensen J, Knuuti J, Christiansen EH, Eftekhari A, Bøttcher M, Winther S. Impact of Absolute Myocardial Blood Flow Quantification on the Diagnostic Performance of PET-Based Perfusion Scans Using 82Rubidium. Circ Cardiovasc Imaging 2024; 17:e016138. [PMID: 38227687 DOI: 10.1161/circimaging.123.016138] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
BACKGROUND Guidelines propose the inclusion of quantitative measurements from 82Rubidium positron emission tomography (RbPET) to discriminate obstructive coronary artery disease (CAD). However, the effect on diagnostic accuracy is unknown. The aim was to investigate the optimal RbPET reading algorithm for improved identification of obstructive CAD. METHODS Prospectively enrolled patients (N=400) underwent RbPET and invasive coronary angiography with fractional flow reserve and quantitative coronary angiography. Quantitative measurements (myocardial blood flow (MBF), MBF reserve, transient ischemic dilatation) by RbPET were step-wisely added to a qualitative assessment by the summed stress score based on their diagnostic accuracy of obstructive CAD by invasive coronary angiography-fractional flow reserve. Prespecified cutoffs were summed stress score ≥4, hyperemic MBF 2.00 mL/g per min, and MBF reserve 1.80, respectively. Hemodynamically obstructive CAD was defined as >90% diameter stenosis or invasive coronary angiography-fractional flow reserve ≤0.80, and sensitivity analyses included a clinically relevant reference of anatomically severe CAD (>70% diameter stenosis by invasive coronary angiography-quantitative coronary angiography). RESULTS Hemodynamically obstructive CAD was present in 170/400 (42.5%) patients. Stand-alone summed stress score showed a sensitivity and specificity of 57% and 93%, respectively, while hyperemic MBF showed similar sensitivity (61%, P=0.57) but lower specificity (85%, P=0.008). With increased discrimination by receiver-operating characteristic curves (0.78 versus 0.85; P<0.001), combining summed stress score, MBF and MBF reserve showed the highest sensitivity of 77% but lower specificity of 74% (P<0.001 for both comparisons). Against anatomically severe CAD, all measures independently yielded high discrimination ≥0.90 with increased sensitivity and lower specificity by additional quantification. CONCLUSIONS The inclusion of quantitative measurements to a RbPET read increases in the identification of obstructive CAD. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT03481712.
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Affiliation(s)
- Laust Dupont Rasmussen
- Department of Cardiology, Gødstrup Hospital, Herning, Denmark (L.D.R., L.L.K., M.B., S.W.)
- Department of Clinical Medicine, Aarhus University, Denmark (L.D.R., M.B., S.W.)
- Department of Cardiology, Aalborg University Hospital, Denmark (L.D.R., A.E.)
| | - Lars Christian Gormsen
- Department of Nuclear Medicine and PET Centre (L.C.C.), Aarhus University Hospital, Denmark
| | | | - Salma Raghad Karim
- Department of Cardiology (S.R.K., J.W., E.H.C.), Aarhus University Hospital, Denmark
| | - Jelmer Westra
- Department of Cardiology (S.R.K., J.W., E.H.C.), Aarhus University Hospital, Denmark
| | - Lars Lyhne Knudsen
- Department of Cardiology, Gødstrup Hospital, Herning, Denmark (L.D.R., L.L.K., M.B., S.W.)
| | - Jane Kirk
- Department of Cardiology, Regional Hospital Central Jutland, Silkeborg, Denmark (J. Kirk)
| | | | - Jesper Mortensen
- Department of Cardiology, Regional Hospital East Jutland, Randers, Denmark (J.M.)
- Department of Nuclear Medicine, Gødstrup Hospital, Herning, Denmark (J.M.)
| | - Juhani Knuuti
- Heart Center, Turku University Hospital, Finland (J. Knuuti)
- Turku PET Centre, Turku University Hospital and University of Turku, Finland (J. Knuuti)
| | - Evald H Christiansen
- Department of Cardiology (S.R.K., J.W., E.H.C.), Aarhus University Hospital, Denmark
| | - Ashkan Eftekhari
- Department of Cardiology, Aalborg University Hospital, Denmark (L.D.R., A.E.)
| | - Morten Bøttcher
- Department of Cardiology, Gødstrup Hospital, Herning, Denmark (L.D.R., L.L.K., M.B., S.W.)
- Department of Clinical Medicine, Aarhus University, Denmark (L.D.R., M.B., S.W.)
| | - Simon Winther
- Department of Cardiology, Gødstrup Hospital, Herning, Denmark (L.D.R., L.L.K., M.B., S.W.)
- Department of Clinical Medicine, Aarhus University, Denmark (L.D.R., M.B., S.W.)
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30
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Amat-Santos IJ, Marengo G, Sánchez-Luna JP, Cortés Villar C, Rivero Crespo F, Jiménez Díaz VA, de la Torre Hernández JM, Pérez de Prado A, Sabaté M, López-Palop R, Vegas Valle JM, Suárez de Lezo J, Fernandez Cordon C, Gonzalez JC, García-Gómez M, Redondo A, Carrasco Moraleja M, San Román JA. Validation of Quantitative Flow Ratio-Derived Virtual Angioplasty with Post-Angioplasty Fractional Flow Reserve-The QIMERA-I Study. J Cardiovasc Dev Dis 2023; 11:14. [PMID: 38248884 PMCID: PMC10816683 DOI: 10.3390/jcdd11010014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 12/25/2023] [Accepted: 12/29/2023] [Indexed: 01/23/2024] Open
Abstract
Background: Quantitative flow ratio (QFR) virtual angioplasty with pre-PCI residual QFR showed better results compared with an angiographic approach to assess post-PCI functional results. However, correlation with pre-PCI residual QFR and post-PCI fractional flow reserve (FFR) is lacking. Methods: A multicenter prospective study including consecutive patients with angiographically 50-90% coronary lesions and positive QFR results. All patients were evaluated with QFR, hyperemic and non-hyperemic pressure ratios (NHPR) before and after the index PCI. Pre-PCI residual QFR (virtual angioplasty) was calculated and compared with post-PCI fractional flow reserve (FFR), QFR and NHPR. Results: A total of 84 patients with 92 treated coronary lesions were included, with a mean age of 65.5 ± 10.9 years and 59% of single vessel lesions being the left anterior descending artery in 69%. The mean vessel diameter was 2.82 ± 0.41 mm. Procedural success was achieved in all cases, with a mean number of implanted stents of 1.17 ± 0.46. The baseline QFR value was 0.69 ± 0.12 and baseline FFR and NHPR were 0.73 ± 0.08 and 0.82 ± 0.11, respectively. Mean post-PCI FFR increased to 0.87 ± 0.05 whereas residual QFR had been estimated as 0.95 ± 0.05, showing poor correlation with post-PCI FFR (0.163; 95% CI:0.078-0.386) and low diagnostic accuracy (30.9%, 95% CI:20-43%). Conclusions: In this analysis, the results of QFR-based virtual angioplasty did not seem to accurately correlate with post-PCI FFR.
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Affiliation(s)
- Ignacio J. Amat-Santos
- Cardiology Department, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain
| | - Giorgio Marengo
- Cardiology Department, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain
| | - Juan Pablo Sánchez-Luna
- Cardiology Department, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain
| | - Carlos Cortés Villar
- Cardiology Department, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain
- Cardiology Department, Hospital Miguel Servet, 50009 Zaragoza, Spain
| | | | | | | | | | - Manel Sabaté
- Cardiology Department, Hospital Clinic Universitari, 08001 Barcelona, Spain
| | - Ramón López-Palop
- Cardiology Department, Hospital Virgen de la Arrixaca, 30120 Murcia, Spain
| | | | | | - Clara Fernandez Cordon
- Cardiology Department, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain
| | - Jose Carlos Gonzalez
- Cardiology Department, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain
| | - Mario García-Gómez
- Cardiology Department, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain
| | - Alfredo Redondo
- Cardiology Department, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain
- Cardiology Department, Hospital Universitario de Santiago, 15706 Santiago de Compostela, Spain
| | | | - J. Alberto San Román
- Cardiology Department, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain
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Spacek M, Vacha J, Kaminek M, Hutyra M, Nykl R, Sluka M, Taborsky M. Comparison of angiographic estimation and invasive hemodynamic measurement of the significance of non-infarct-related residual stenoses in ST-elevation myocardial infarction patients. Arch Med Sci Atheroscler Dis 2023; 8:e169-e176. [PMID: 38283928 PMCID: PMC10811533 DOI: 10.5114/amsad/172971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 09/27/2023] [Indexed: 01/30/2024] Open
Abstract
Introduction Up to 50% of patients with ST elevation myocardial infarction (STEMI) have ≥ 50% stenosis in a major non-infarct-related artery. Several studies have evaluated the prognostic value of the completion of revascularization with overall inconclusive results. Selection of the stenoses was based on the angiographic evaluation, invasive hemodynamic measurement or the combined approach. It is unknown whether such a selection provides correlation of comparable patient groups. Material and methods We enrolled 51 patients (62.7 ±10.2 years) with acute STEMI and at least one residual (50-90%) stenosis in a non-infarct-related major coronary artery (excluding left main coronary artery). Overall 65 stenoses (67.9 ±10.7%) were evaluated angiographically following primary percutaneous coronary intervention and the hemodynamic significance was estimated with respect to the stenosis severity, caliber of the arterial segment, localization of the stenosis (proximity) as well as the estimated size of the supplied vascular territory. During subsequent hospitalization, invasive measurement of the hemodynamic significance using fractional flow reserve (FFR) was performed to guide the final revascularization strategy (FFR value of ≤ 0.80 considered significant). Results Based on angiographic evaluation, a total of 44 stenoses would be recommended for treatment, whereas only 31 stenoses were revascularized based on FFR measurement. Moreover, visual evaluation and hemodynamic measurement were discrepant in 27 of 65 (41.5%) stenoses. Conclusions We observed a weak correlation between visual angiographic evaluation and invasive hemodynamic measurement. More stents would be implanted based on angiographic evaluation compared to FFR measurement.
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Affiliation(s)
- Miloslav Spacek
- Department of Internal Medicine I – Cardiology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic
| | - Jan Vacha
- Department of Internal Medicine I – Cardiology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic
| | - Milan Kaminek
- Department of Nuclear Medicine, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic
| | - Martin Hutyra
- Department of Internal Medicine I – Cardiology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic
| | - Radomir Nykl
- Department of Internal Medicine I – Cardiology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic
| | - Martin Sluka
- Department of Internal Medicine I – Cardiology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic
| | - Milos Taborsky
- Department of Internal Medicine I – Cardiology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic
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Ciaramella L, Di Serafino L, Mitrano L, De Rosa ML, Carbone C, Rea FS, Monaco S, Scalamogna M, Cirillo P, Esposito G. Invasive Assessment of Coronary Microcirculation: A State-of-the-Art Review. Diagnostics (Basel) 2023; 14:86. [PMID: 38201395 PMCID: PMC10795746 DOI: 10.3390/diagnostics14010086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 12/28/2023] [Accepted: 12/28/2023] [Indexed: 01/12/2024] Open
Abstract
A significant proportion of patients presenting with signs and symptoms of myocardial ischemia have no "significant" epicardial disease; thereby, the assessment of coronary microcirculation gained an important role in improving diagnosis and guiding therapy. In fact, coronary microvascular dysfunction (CMD) could be found in a large proportion of these patients, supporting both symptoms and signs of myocardial ischemia. However, CMD represents a diagnostic challenge for two main reasons: (1) the small dimension of the coronary microvasculature prevents direct angiographic visualization, and (2) despite the availability of specific diagnostic tools, they remain invasive and underused in the current clinical practice. For these reasons, CMD remains underdiagnosed, and most of the patients remain with no specific treatment and quality-of-life-limiting symptoms. Of note, recent evidence suggests that a "full physiology" approach for the assessment of the whole coronary vasculature may offer a significant benefit in terms of symptom improvement among patients presenting with ischemia and non-obstructive coronary artery disease. We analyze the pathophysiology of coronary microvascular dysfunction, providing the readers with a guide for the invasive assessment of coronary microcirculation, together with the available evidence supporting its use in clinical practice.
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Affiliation(s)
| | - Luigi Di Serafino
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy; (L.C.); (L.M.); (M.L.D.R.); (C.C.); (F.S.R.); (S.M.); (M.S.); (P.C.); (G.E.)
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33
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van Diemen PA, de Winter RW, Schumacher SP, Everaars H, Bom MJ, Jukema RA, Somsen YB, Raijmakers PG, Kooistra RA, Timmer J, Maaniitty T, Robbers LF, von Bartheld MB, Demirkiran A, van Rossum AC, Reiber JH, Knuuti J, Underwood SR, Nagel E, Knaapen P, Driessen RS, Danad I. The diagnostic performance of quantitative flow ratio and perfusion imaging in patients with prior coronary artery disease. Eur Heart J Cardiovasc Imaging 2023; 25:116-126. [PMID: 37578007 PMCID: PMC10735295 DOI: 10.1093/ehjci/jead197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/07/2023] [Accepted: 07/20/2023] [Indexed: 08/15/2023] Open
Abstract
AIMS In chronic coronary syndrome (CCS) patients with documented coronary artery disease (CAD), ischaemia detection by myocardial perfusion imaging (MPI) and an invasive approach are viable diagnostic strategies. We compared the diagnostic performance of quantitative flow ratio (QFR) with single-photon emission computed tomography (SPECT), positron emission tomography (PET), and cardiac magnetic resonance imaging (CMR) in patients with prior CAD [previous percutaneous coronary intervention (PCI) and/or myocardial infarction (MI)]. METHODS AND RESULTS This PACIFIC-2 sub-study evaluated 189 CCS patients with prior CAD for inclusion. Patients underwent SPECT, PET, and CMR followed by invasive coronary angiography with fractional flow reserve (FFR) measurements of all major coronary arteries (N = 567), except for vessels with a sub-total or chronic total occlusion. Quantitative flow ratio computation was attempted in 488 (86%) vessels with measured FFR available (FFR ≤0.80 defined haemodynamically significant CAD). Quantitative flow ratio analysis was successful in 334 (68%) vessels among 166 patients and demonstrated a higher accuracy (84%) and sensitivity (72%) compared with SPECT (66%, P < 0.001 and 46%, P = 0.001), PET (65%, P < 0.001 and 58%, P = 0.032), and CMR (72%, P < 0.001 and 33%, P < 0.001). The specificity of QFR (87%) was similar to that of CMR (83%, P = 0.123) but higher than that of SPECT (71%, P < 0.001) and PET (67%, P < 0.001). Lastly, QFR exhibited a higher area under the receiver operating characteristic curve (0.89) than SPECT (0.57, P < 0.001), PET (0.66, P < 0.001), and CMR (0.60, P < 0.001). CONCLUSION QFR correlated better with FFR in patients with prior CAD than MPI, as reflected in the higher diagnostic performance measures for detecting FFR-defined, vessel-specific, significant CAD.
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Affiliation(s)
- Pepijn A van Diemen
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam 1081 HV, The Netherlands
| | - Ruben W de Winter
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam 1081 HV, The Netherlands
| | - Stefan P Schumacher
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam 1081 HV, The Netherlands
| | - Henk Everaars
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam 1081 HV, The Netherlands
| | - Michiel J Bom
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam 1081 HV, The Netherlands
| | - Ruurt A Jukema
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam 1081 HV, The Netherlands
| | - Yvemarie B Somsen
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam 1081 HV, The Netherlands
| | - Pieter G Raijmakers
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | | | - Teemu Maaniitty
- Turku PET Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Lourens F Robbers
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam 1081 HV, The Netherlands
| | - Martin B von Bartheld
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam 1081 HV, The Netherlands
| | - Ahmet Demirkiran
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam 1081 HV, The Netherlands
| | - Albert C van Rossum
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam 1081 HV, The Netherlands
| | | | - Juhani Knuuti
- Turku PET Centre, Turku University Hospital and University of Turku, Turku, Finland
| | | | - Eike Nagel
- Institute of Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, University Hospital Frankfurt am Main, Frankfurt am Main, Germany
| | - Paul Knaapen
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam 1081 HV, The Netherlands
| | - Roel S Driessen
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam 1081 HV, The Netherlands
| | - Ibrahim Danad
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam 1081 HV, The Netherlands
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Grines CL, DuPont A. Lesion Selection and Optimizing PCI: Intravascular Hemodynamics, Imaging, or Both? J Am Coll Cardiol 2023; 82:2177-2178. [PMID: 38030346 DOI: 10.1016/j.jacc.2023.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023]
Affiliation(s)
- Cindy L Grines
- Northside Hospital Cardiovascular Institute, Atlanta, Georgia, USA.
| | - Allison DuPont
- Northside Hospital Cardiovascular Institute, Atlanta, Georgia, USA
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Kuno T, Kiyohara Y, Maehara A, Ueyama HA, Kampaktsis PN, Takagi H, Mehran R, Stone GW, Bhatt DL, Mintz GS, Bangalore S. Comparison of Intravascular Imaging, Functional, or Angiographically Guided Coronary Intervention. J Am Coll Cardiol 2023; 82:2167-2176. [PMID: 37995152 DOI: 10.1016/j.jacc.2023.09.823] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/27/2023] [Accepted: 09/28/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND In patients undergoing percutaneous coronary intervention (PCI), it remains unclear whether intravascular imaging guidance or functional guidance is the best strategy to optimize outcomes and if the results are different in patients with vs without acute coronary syndromes (ACS). OBJECTIVES The purpose of this study was to evaluate clinical outcomes with imaging-guided PCI or functionally guided PCI when compared with conventional angiography-guided PCI. METHODS We searched PUBMED and EMBASE for randomized controlled trials investigating outcomes with intravascular imaging-guided, functionally guided, or angiography-guided PCI. The primary outcome from this network meta-analysis was trial-defined major adverse cardiovascular event (MACE)-a composite of cardiovascular death, myocardial infarction (MI), and target lesion revascularization (TLR). PCI strategies were ranked (best to worst) using P scores. RESULTS Our search identified 32 eligible randomized controlled trials and included a total of 22,684 patients. Compared with angiography-guided PCI, intravascular imaging-guided PCI was associated with reduced risk of MACE (relative risk [RR]: 0.72; 95% CI: 0.62-0.82), cardiovascular death (RR: 0.56; 95% CI: 0.42-0.75), MI (RR: 0.81; 95% CI: 0.66-0.99), stent thrombosis (RR: 0.48; 95% CI: 0.31-0.73), and TLR (RR: 0.75; 95% CI: 0.57-0.99). Similarly, when compared with angiography-guided PCI, functionally guided PCI was associated with reduced risk of MACE and MI. Intravascular imaging-guided PCI ranked first for the outcomes of MACE, cardiovascular death, stent thrombosis, and TLR. The results were consistent in the ACS and non-ACS cohorts. CONCLUSIONS Angiography-guided PCI had consistently worse outcomes compared with intravascular imaging-guided and functionally guided PCI. Intravascular imaging-guided PCI was the best strategy to reduce the risk of cardiovascular events.
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Affiliation(s)
- Toshiki Kuno
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York, USA; Division of Cardiology, Jacobi Medical Center, Albert Einstein College of Medicine, New York, New York, USA.
| | - Yuko Kiyohara
- Department of Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Akiko Maehara
- Cardiovascular Research Foundation, New York, New York, USA; Division of Cardiology, Department of Medicine, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Hiroki A Ueyama
- Division of Cardiology, Emory University, Atlanta, Georgia, USA
| | - Polydoros N Kampaktsis
- Division of Cardiology, Department of Medicine, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Hisato Takagi
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Gregg W Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Deepak L Bhatt
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai Health System, New York, New York, USA
| | - Gary S Mintz
- Cardiovascular Research Foundation, New York, New York, USA
| | - Sripal Bangalore
- Division of Cardiovascular Medicine, New York University Grossman School of Medicine, New York, New York, USA.
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Wong CC, Fearon WF. Where Do We Go With Abnormal Flow? JACC Asia 2023; 3:878-880. [PMID: 38155800 PMCID: PMC10751635 DOI: 10.1016/j.jacasi.2023.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/30/2023]
Affiliation(s)
- Christopher C.Y. Wong
- Division of Cardiovascular Medicine and Cardiovascular Institute, Stanford University School of Medicine, Stanford, California, USA
- VA Palo Alto Health Care System, Palo Alto, California, USA
| | - William F. Fearon
- Division of Cardiovascular Medicine and Cardiovascular Institute, Stanford University School of Medicine, Stanford, California, USA
- VA Palo Alto Health Care System, Palo Alto, California, USA
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37
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Liu X, Zhang Y, Xu Y, Tang Z, Wang X, Nie S, Mintz GS. Fractional flow reserve versus intravascular imaging to guide decision-making for percutaneous coronary intervention in intermediate lesions: A meta-analysis. Catheter Cardiovasc Interv 2023; 102:1198-1209. [PMID: 37937727 DOI: 10.1002/ccd.30909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 10/27/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND Both fractional flow reserve (FFR) and intravascular imaging (IVI) have been used to guide the decision-making for percutaneous coronary intervention (PCI) in intermediate coronary stenosis. Nevertheless, studies that directly compared the prognostic significance of these two strategies are scarce. AIMS The aim of this meta-analyses was to evaluate the impact of FFR versus IVI to guide the decision-making in PCI for intermediate stenosis on clinical outcomes. METHODS We systematically searched PubMed, Embase, Cochrane, and relevant database from inception date to September 2022 for observational studies and randomized clinical trials (RCTs) which compared FFR and IVI-based decision-making in PCI for intermediate stenosis. The primary outcome was a composite of major adverse cardiac event (MACE). Pooled risk ratios (RR) were calculated using random effects models and heterogeneity were evaluated with the I2 statistic. RESULTS We identified 5 studies (3 RCTs and 2 observational studies) with 3208 patients. The follow-up duration ranged from 12 to 24 months. Among five studies, four compared FFR with intravascular ultrasound while one compared FFR with optical coherence tomography. There was no statistically difference between FFR and IVI in the incidence of MACE (RR: 1.19; 95% confidence interval: 0.85-1.68; p = 0.31) and its individual components. These results were consistent regardless of various cut-off value of PCI across the studies. Compared with IVI, FFR was associated with a lower PCI rate (37.0% vs. 60.3%; p < 0.001). CONCLUSIONS The decision to perform PCI for intermediate stenosis guided by FFR or IVI showed a similar clinical outcome. The use of FFR significantly reduced the need for PCI.
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Affiliation(s)
- Xiaochen Liu
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yushi Zhang
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yang Xu
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Zhe Tang
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiao Wang
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Shaoping Nie
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Gary S Mintz
- Cardiovascular Research Foundation, New York, New York, USA
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Luo Y, Mao M, Wu F, Ma K, Chang J, Xiang R. Diagnostic performance of resting full-cycle ratio in identifying coronary lesions causing myocardial ischaemia: a meta-analysis. Acta Cardiol 2023; 78:1103-1109. [PMID: 37811658 DOI: 10.1080/00015385.2023.2250944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 08/17/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND The resting full-cycle ratio (RFR), a new non-congestive resting index, is commonly used for physiological evaluations of coronary arteries. AIMS This study aims to evaluate the accuracy of RFR in detecting coronary artery stenosis with hemodynamic significance using fractional flow reserve (FFR) as the reference standard. METHODS Using 'RFR, resting full-cycle ratio' as the search term, we searched PubMed, Embase, Cochrane Library, and Web of Science databases, screening the literature according to the inclusion and exclusion criteria. By applying FFR ≤ 0.80 and RFR ≤ 0.89 as the diagnostic criteria for ischaemia, we analysed the synthetic sensitivity, specificity, and corresponding 95% confidence intervals, then synthesised the summary receiver operating characteristic curve (SROC). RESULTS Three studies were included in this meta-analysis, comprising 1,084 patients with 1,312 lesions. When we used FFR ≤ 0.80 as the reference standard, the synthesised sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+), and negative likelihood ratio (LR-) of RFR in the diagnosis of coronary ischaemia were 73%, 81%, 67%, 85%, 3.95, and 0.33, respectively. Besides, the area under the curve (AUC) was 0.8276. CONCLUSION Using FFR as the reference standard, RFR has good diagnostic accuracy in detecting coronary ischaemic lesions and may be an effective alternative to FFR in the future, to some extent.
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Affiliation(s)
- Yue Luo
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Min Mao
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Fan Wu
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Kanghua Ma
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jing Chang
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Rui Xiang
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Milzi A, Dettori R, Lubberich RK, Reith S, Burgmaier K, Marx N, Burgmaier M. Quantitative Flow Ratio Is Feasible and Accurate Even at Lower Frame Acquisition Rate. Circ Cardiovasc Interv 2023; 16:e013266. [PMID: 37846560 DOI: 10.1161/circinterventions.123.013266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Affiliation(s)
- Andrea Milzi
- Department of Internal Medicine I, University Hospital of the RWTH Aachen, Germany (A.M., R.D., R.K.L., N.M., M.B.)
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale (EOC), Università Della Svizzera Italiana, Lugano, Switzerland (A.M.)
| | - Rosalia Dettori
- Department of Internal Medicine I, University Hospital of the RWTH Aachen, Germany (A.M., R.D., R.K.L., N.M., M.B.)
| | - Richard Karl Lubberich
- Department of Internal Medicine I, University Hospital of the RWTH Aachen, Germany (A.M., R.D., R.K.L., N.M., M.B.)
| | - Sebastian Reith
- Department of Cardiology, Angiology and Electrophysiology, St. Franziskus Hospital, Münster, Germany (S.R.)
| | - Kathrin Burgmaier
- Faculty of Applied Healthcare Science, Deggendorf Institute of Technology, Germany (K.B., M.B.)
| | - Nikolaus Marx
- Department of Internal Medicine I, University Hospital of the RWTH Aachen, Germany (A.M., R.D., R.K.L., N.M., M.B.)
| | - Mathias Burgmaier
- Department of Internal Medicine I, University Hospital of the RWTH Aachen, Germany (A.M., R.D., R.K.L., N.M., M.B.)
- Faculty of Applied Healthcare Science, Deggendorf Institute of Technology, Germany (K.B., M.B.)
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Yang S, Hwang D, Lee JM, Lee SH, Boerhout CK, Woudstra J, Vink CE, de Waard GA, Jung JH, Renteria HM, Hoshino M, Pinto ME, Meuwissen M, Matsuo H, Cambero MM, Eftekhari A, Effat MA, Murai T, Marques K, Appelman Y, Doh JH, Christiansen EH, Banerjee R, Kim HK, Nam CW, Niccoli G, Nakayama M, Tanaka N, Shin ES, Beijk MA, Chamuleau SA, van Royen N, Knaapen P, Kakuta T, Escaned J, Piek JJ, van de Hoef TP, Koo BK. Prognostic Implications of Individual and Combinations of Resting and Hyperemic Coronary Pressure and Flow Parameters. JACC Asia 2023; 3:865-877. [PMID: 38155797 PMCID: PMC10751649 DOI: 10.1016/j.jacasi.2023.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/11/2023] [Accepted: 07/15/2023] [Indexed: 12/30/2023]
Abstract
Background Coronary pressure- and flow-derived parameters have prognostic value. Objectives This study aims to investigate the individual and combined prognostic relevance of pressure and flow parameters reflecting resting and hyperemic conditions. Methods A total of 1,971 vessels deferred from revascularization after invasive pressure and flow assessment were included from the international multicenter registry. Abnormal resting pressure and flow were defined as distal coronary pressure/aortic pressure ≤0.92 and high resting flow (1/resting mean transit time >2.4 or resting average peak flow >22.7 cm/s), and abnormal hyperemic pressure and flow as fractional flow reserve ≤0.80 and low hyperemic flow (1/hyperemic mean transit time <2.2 or hyperemic average peak flow <25.0 cm/s), respectively. The clinical endpoint was target vessel failure (TVF), myocardial infarction (MI), or cardiac death at 5 years. Results The mean % diameter stenosis was 46.8% ± 16.5%. Abnormal pressure and flow were independent predictors of TVF and cardiac death/MI (all P < 0.05). The risk of 5-year TVF or MI/cardiac death increased proportionally with neither, either, and both abnormal resting pressure and flow, and abnormal hyperemic pressure and flow (all P for trend < 0.001). Abnormal resting pressure and flow were associated with a higher rate of TVF or MI/cardiac death in vessels with normal fractional flow reserve; this association was similar for abnormal hyperemic pressure and flow in vessels with normal resting distal coronary pressure/aortic pressure (all P < 0.05). Conclusions Abnormal resting and hyperemic pressure and flow were independent prognostic predictors. The abnormal flow had an additive prognostic value for pressure in both resting and hyperemic conditions with complementary prognostic between resting and hyperemic parameters.
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Affiliation(s)
- Seokhun Yang
- Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Doyeon Hwang
- Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Joo Myung Lee
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Hun Lee
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Coen K.M. Boerhout
- Department of Cardiology, Amsterdam UMC location AMC, Amsterdam, The Netherlands
| | - Janneke Woudstra
- Department of Cardiology, Amsterdam UMC location AMC, Amsterdam, The Netherlands
| | - Caitlin E.M. Vink
- Department of Cardiology, Amsterdam UMC location AMC, Amsterdam, The Netherlands
| | - Guus A. de Waard
- Department of Cardiology, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
| | - Ji Hyun Jung
- Sejong General Hospital, Sejong Heart Institute, Bucheon, Korea
| | - Hernan Mejia Renteria
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Madrid, Spain
| | - Masahiro Hoshino
- Tsuchiura Kyodo General Hospital, Department of Cardiology, Tsuchiura city, Japan
| | - Mauro Echavarria Pinto
- Hospital General ISSSTE Querétaro Facultad de Medicina, Universidad Autónoma de Querétaro, Querétaro, México
| | | | - Hitoshi Matsuo
- Gifu Heart Center, Department of Cardiovascular Medicine, Gifu, Japan
| | | | - Ashkan Eftekhari
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - Mohamed A. Effat
- Division of Cardiovascular Health and Disease, University of Cincinnati, Cincinnati, Ohio, USA
| | - Tadashi Murai
- Tsuchiura Kyodo General Hospital, Department of Cardiology, Tsuchiura city, Japan
| | - Koen Marques
- Department of Cardiology, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
| | - Yolande Appelman
- Department of Cardiology, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
| | - Joon Hyung Doh
- Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | | | - Rupak Banerjee
- Department of Mechanical and Materials Engineering, University of Cincinnati, Veterans Affairs Medical Center, Cincinnati, Ohio, USA
| | - Hyun Kuk Kim
- Department of Internal Medicine and Cardiovascular Center, Chosun University Hospital, University of Chosun College of Medicine, Gwangju, Korea
| | - Chang Wook Nam
- Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
| | | | - Masafumi Nakayama
- Gifu Heart Center, Department of Cardiovascular Medicine, Gifu, Japan
- Toda Central General Hospital, Cardiovascular Center, Toda, Japan
| | - Nobuhiro Tanaka
- Tokyo Medical University Hachioji Medical Center, Department of Cardiology, Tokyo, Japan
| | - Eun Seok Shin
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Marcel A.M. Beijk
- Department of Cardiology, Amsterdam UMC location AMC, Amsterdam, The Netherlands
| | - Steven A.J. Chamuleau
- Department of Cardiology, Amsterdam UMC location AMC, Amsterdam, The Netherlands
- Department of Cardiology, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
| | - Niels van Royen
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Paul Knaapen
- Department of Cardiology, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
| | - Tsunekazu Kakuta
- Tsuchiura Kyodo General Hospital, Department of Cardiology, Tsuchiura city, Japan
| | - Javier Escaned
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Madrid, Spain
| | - Jan J. Piek
- Department of Cardiology, Amsterdam UMC location AMC, Amsterdam, The Netherlands
| | - Tim P. van de Hoef
- Department of Cardiology, Amsterdam UMC location AMC, Amsterdam, The Netherlands
- Department of Cardiology, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
- Department of Cardiology, NoordWest Ziekenhuisgroep, the Netherlands
| | - Bon-Kwon Koo
- Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Ben-Assa E, Abu Salman A, Cafri C, Roguin A, Hellou E, Koifman E, Feld Y, Lev E, Sheinman G, Harari E, Abu Dogosh A, Beyar R, Garcia-Garcia HM, Davies J, Ben-Yehuda O. Performance of a novel artificial intelligence software developed to derive coronary fractional flow reserve values from diagnostic angiograms. Coron Artery Dis 2023; 34:533-541. [PMID: 37855304 PMCID: PMC10602213 DOI: 10.1097/mca.0000000000001305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 09/11/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Although invasive measurement of fractional flow reserve (FFR) is recommended to guide revascularization, its routine use is underutilized. Recently, a novel non-invasive software that can instantaneously produce FFR values from the diagnostic angiograms, derived completely from artificial intelligence (AI) algorithms has been developed. We aim to assess the accuracy and diagnostic performance of AI-FFR in a real-world retrospective study. METHODS Retrospective, three-center study comparing AI-FFR values with invasive pressure wire-derived FFR obtained in patients undergoing routine diagnostic angiography. The accuracy, sensitivity, and specificity of AI-FFR were analyzed. RESULTS A total of 304 vessels from 297 patients were included. Mean invasive FFR was 0.86 vs. 0.85 AI-FFR (mean difference: -0.005, P = 0.159). The diagnostic performance of AI-FFR demonstrated sensitivity of 91%, specificity 95%, positive predictive value 83% and negative predictive value 97%. Overall accuracy was 94% and the area under curve was 0.93 (95% CI 0.88-0.97). 105 lesions fell around the cutoff value (FFR = 0.75-0.85); in this sub-group, AI-FFR demonstrated sensitivity of 95%, and specificity 94%, with an AUC of 0.94 (95% CI 88.2-98.0). AI-FFR calculation time was 37.5 ± 7.4 s for each angiographic video. In 89% of cases, the software located the target lesion and in 11%, the operator manually marked the target lesion. CONCLUSION AI-FFR calculated by an AI-based, angio-derived method, demonstrated excellent diagnostic performance against invasive FFR. AI-FFR calculation was fast with high reproducibility.
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Affiliation(s)
- Eyal Ben-Assa
- Cardiology Division, Assuta Ashdod University Hospital, Ben-Gurion University of the Negev, Ashdod, Israel
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Amjad Abu Salman
- Cardiology Division, Soroka Medical Center, Ben-Gurion University of the Negev, Beer Sheva
| | - Carlos Cafri
- Cardiology Division, Soroka Medical Center, Ben-Gurion University of the Negev, Beer Sheva
| | - Ariel Roguin
- Department of Cardiology, Hillel Yaffe Medical Center, Hadera, Ruth and Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa
| | - Elias Hellou
- Department of Cardiology, Hillel Yaffe Medical Center, Hadera, Ruth and Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa
| | - Edward Koifman
- Department of Cardiology, Meir Medical Center, Tel Aviv University, Kfar Saba
| | - Yair Feld
- Department of Cardiology, Rambam Health Care Campus, Ruth and Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel
| | - Eli Lev
- Cardiology Division, Assuta Ashdod University Hospital, Ben-Gurion University of the Negev, Ashdod, Israel
| | - Guy Sheinman
- Cardiology Division, Assuta Ashdod University Hospital, Ben-Gurion University of the Negev, Ashdod, Israel
| | - Emanuel Harari
- Cardiology Division, Assuta Ashdod University Hospital, Ben-Gurion University of the Negev, Ashdod, Israel
| | - Ala Abu Dogosh
- Cardiology Division, Soroka Medical Center, Ben-Gurion University of the Negev, Beer Sheva
| | - Rafael Beyar
- Department of Cardiology, Rambam Health Care Campus, Ruth and Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel
| | | | - Justine Davies
- International Centre for Circulatory Health, Imperial College, NHS Trust, London, UK
| | - Ori Ben-Yehuda
- Sulpizio Cardiovascular Institute, University of California, San Diego, La Jolla, California, USA
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Yang H, Song Y, Cao J, Chen J, Zhang F, Huang Z, Qian J, Ge J. A novel hybrid strategy of drug coated balloon and stent for coronary bifurcation lesions. SCAND CARDIOVASC J 2023; 57:2161620. [PMID: 36573618 DOI: 10.1080/14017431.2022.2161620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background. Provisional side branch (SB) stenting strategy is the default approach for the majority of bifurcation lesions, but outcomes of SB is suboptimal. Though drug coated balloon (DCB) improving SB outcomes attracts an increasing attention, sequence of DCB hasn't yet been determined. We presented a novel hybrid strategy of DCB and stent for bifurcation lesions. Methods. With lesion preparation, DCB was persistently inflated in SB kissing with main branch (MB) stent deployment and balloon post-dilation of the bifurcation core. Proximal optimization technique was performed strictly not exceeding the bifurcation. Procedural and clinical adverse events were evaluated. Canadian Cardiovascular Society (CCS) angina classification was assessed at baseline and clinical follow-up. Results. Fourteen patients undergoing the hybrid technique from August 2020 to July 2021 were enrolled. The technique was successfully performed in all patients without rewiring or SB compromise. Minimal lumen diameter of SB increased from 0.60 ± 0.40 mm to 2.1 ± 0.2 mm while the percent stenosis decreased from 72.4 ± 17.9% to 19.6 ± 4.7%. In addition, intravascular ultrasound indicated comparable stent symmetry index and incomplete stent apposition between proximal and distal segments of stent. No further intervention was performed, and mean fractional flow reserve of SB (n = 12) was 0.88 ± 0.05. No major adverse cardiac events was noted in hospital and 12-month follow up. The mean CCS angina score was reduced by 84% (2.2 vs 0.4, p < .001). Conclusion. The hybrid strategy facilitates treatment of DCB and stent for bifurcation lesions, which appears to be feasible and acceptable in a short-term follow-up.
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Affiliation(s)
- Hongbo Yang
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Fudan University, Shanghai, China.,Shanghai Clinical Research Center for Interventional Medicine, Fudan University, Shanghai, China
| | - Yanan Song
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Fudan University, Shanghai, China.,Shanghai Clinical Research Center for Interventional Medicine, Fudan University, Shanghai, China
| | - Jiatian Cao
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Fudan University, Shanghai, China.,Shanghai Clinical Research Center for Interventional Medicine, Fudan University, Shanghai, China
| | - Jing Chen
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Fudan University, Shanghai, China.,Shanghai Clinical Research Center for Interventional Medicine, Fudan University, Shanghai, China
| | - Feng Zhang
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Fudan University, Shanghai, China.,Shanghai Clinical Research Center for Interventional Medicine, Fudan University, Shanghai, China
| | - Zheyong Huang
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Fudan University, Shanghai, China.,Shanghai Clinical Research Center for Interventional Medicine, Fudan University, Shanghai, China
| | - Juying Qian
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Fudan University, Shanghai, China.,Shanghai Clinical Research Center for Interventional Medicine, Fudan University, Shanghai, China
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Fudan University, Shanghai, China.,Shanghai Clinical Research Center for Interventional Medicine, Fudan University, Shanghai, China
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Chu J, Yuan D, Lai Y, Ye W, Liu L, Lin H, Ping F, Zhu G, Chen F, Yao Y, Yan W, Liu X. Prognostic Implications of Changes in Total Physiological Atherosclerotic Burden in Patients With Coronary Artery Disease-A Serial QFR Study. Angiology 2023:33197231218616. [PMID: 37994827 DOI: 10.1177/00033197231218616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
The association between coronary physiological progression and clinical outcomes has not been investigated. A total of 421 patients who underwent serial coronary angiography at least 6 months apart were included. Total physiological atherosclerotic burden was characterized by sum of quantitative flow ratio in 3 epicardial vessels (3V-QFR). The relationships of the 3V-QFR and its longitudinal change (△3V-QFR) with major adverse cardiovascular events (MACE) were explored. 3V-QFR values derived from follow-up angiograms were slightly lower compared with baseline (2.85 [2.77, 2.90] vs 2.86 [2.80, 2.90], P < .001). The median △3V-QFR value was -0.01 (-0.05, 0.02). The multivariable models demonstrated that follow-up 3V-QFR and △3V-QFR were independently associated with MACE (both P < .05). Patients with both low follow-up 3V-QFR (≤2.78) and low △3V-QFR (≤-0.05) presented 3 times higher risk of MACE than those without (hazard ratio: 2.953, 95% confidence interval 1.428-6.104, P = .003). Furthermore, adding patient-level 3V-QFR and △3V-QFR to clinical model significantly improved the predictability for MACE. In conclusion, total physiological atherosclerotic burden and its progression can provide incremental prognostic value over clinical characteristics, supporting the use of coronary physiology in the evaluation of disease progression and for the identification of vulnerable patients.
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Affiliation(s)
- Jiapeng Chu
- Department of Cardiology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Deqiang Yuan
- Department of Cardiology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yan Lai
- Department of Cardiology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Wen Ye
- Department of Cardiology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Lei Liu
- Department of Cardiology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Hao Lin
- Department of Cardiology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Fan Ping
- Department of Cardiology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Guoqi Zhu
- Department of Cardiology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Fei Chen
- Department of Cardiology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yian Yao
- Department of Cardiology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Wenwen Yan
- Department of Cardiology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Xuebo Liu
- Department of Cardiology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
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Sreenivasan J, Jamil Y, Ahmad Y. Revascularization and Mortality at 5 Years After Treatment Guided By Instantaneous Wave-Free Ratio and Fractional Flow Reserve: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Am Heart Assoc 2023; 12:e032015. [PMID: 37982225 PMCID: PMC10727296 DOI: 10.1161/jaha.123.032015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 09/22/2023] [Indexed: 11/21/2023]
Affiliation(s)
| | - Yasser Jamil
- Section of Cardiovascular MedicineYale UniversityNew HavenCTUSA
| | - Yousif Ahmad
- Section of Cardiovascular MedicineYale UniversityNew HavenCTUSA
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45
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Faroux L, Villecourt A, Metz D. The Management of Coronary Artery Disease in TAVR Patients. J Clin Med 2023; 12:7126. [PMID: 38002738 PMCID: PMC10672348 DOI: 10.3390/jcm12227126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 11/01/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023] Open
Abstract
About half of the transcatheter aortic valve replacement (TAVR) recipients exhibit some degree of coronary artery disease (CAD), and controversial results have been reported regarding the impact of the presence and severity of CAD on clinical outcomes post-TAVR. In addition to coronary angiography, promising data has been recently reported on the use of both cardiac computed tomography angiography and the functional invasive assessment of coronary lesions whether by FFR or iFR in the work-up pre-TAVR. Despite mitigated available data, percutaneous revascularization of significant coronary lesions has been the routine strategy in TAVR candidates with CAD. Additionally, scarce data exists on the incidence, characteristics and management of coronary events post-TAVR, and increasing interest exists on the potential coronary access challenges in patients requiring coronary angiography/intervention post-TAVR. This review provides an updated overview of the knowledge of CAD in TAVR recipients, focusing on its prevalence, clinical impact, pre- and post-procedural evaluation and management.
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Affiliation(s)
- Laurent Faroux
- Cardiology Department, Reims University Hospital, 51100 Reims, France
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Saito T, Shiono Y, Nagamine S, Fujita M, Okimoto T, Okabe T, Keida T, Ohira H, Kawase Y, Murata N, Yamashita J, Matsuo A, Fujita H, Takashima H, Amano T, Hokama Y, Matsuo H, Tanaka N, Akasaka T. Prognostic Values of Fractional Flow Reserve Based on Clinical Outcomes in Patients on Chronic Hemodialysis. Am J Cardiol 2023; 207:441-447. [PMID: 37797551 DOI: 10.1016/j.amjcard.2023.08.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 08/17/2023] [Accepted: 08/20/2023] [Indexed: 10/07/2023]
Abstract
The fractional flow reserve (FFR) cut-off values of 0.75 or 0.8 have been widely used; however, whether they apply to patients on hemodialysis remains unknown. We aimed to investigate the cut-off value of FFR associated with clinical outcomes in patients on hemodialysis. Using the Japanese multicenter registry, we analyzed data of patients on hemodialysis with measured FFR between January 2010 and December 2016. Survival classification and regression tree analysis for the composite primary outcome of cardiovascular mortality, myocardial infarction, and target vessel revascularization revealed a threshold FFR of 0.83. Multivariate Cox regression analyses were performed for the clinical outcomes. Additionally, the primary outcome was analyzed using propensity score matching by dividing the patients into complete and incomplete revascularization groups according to the presence of residual lesions with an FFR of ≤0.83 after the intervention. Of the 212 included patients, 112 (52.8%) had lesions with an FFR of ≤0.83. After adjusting for confounders, an FFR of ≤0.83 was associated with a higher risk for the primary outcome (adjusted hazard ratio 2.01, 95% confidence interval 1.11 to 3.66, p = 0.021). Propensity score matching showed that complete revascularization for lesions with an FFR of ≤0.83 was associated with a reduced risk for the primary outcome compared with incomplete revascularization (hazard ratio 0.38, 95% confidence interval 0.20 to 0.71, log-rank p = 0.0016). In conclusion, an FFR of ≤0.83 was an independent predictor of clinical events in patients on hemodialysis. Furthermore, complete revascularization was associated with better clinical outcomes. Thus, this population may require a distinct FFR cut-off value.
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Affiliation(s)
- Tetsuya Saito
- Department of Cardiology, Edogawa Hospital, Tokyo, Japan.
| | - Yasutsugu Shiono
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Sho Nagamine
- Department of Cardiology, Edogawa Hospital, Tokyo, Japan
| | - Masaki Fujita
- Department of Cardiology, Edogawa Hospital, Tokyo, Japan
| | | | - Teruo Okabe
- Department of Cardiology, Edogawa Hospital, Tokyo, Japan
| | - Takehiko Keida
- Department of Cardiology, Edogawa Hospital, Tokyo, Japan
| | - Hiroshi Ohira
- Department of Cardiology, Edogawa Hospital, Tokyo, Japan
| | - Yoshiaki Kawase
- Department of Cardiovascular Medicine. Gifu Heart Center, Gifu, Japan
| | - Naotaka Murata
- Department of Cardiology, Tokyo Medical University, Tokyo, Japan
| | - Jun Yamashita
- Department of Cardiology, Tokyo Medical University, Tokyo, Japan
| | - Akiko Matsuo
- Department of Cardiology, Kyoto City Hospital, Kyoto, Japan
| | - Hiroshi Fujita
- Department of Cardiology, Kyoto City Hospital, Kyoto, Japan
| | | | - Tetsuya Amano
- Department of Cardiology, Aichi Medical University, Aichi, Japan
| | - Yohei Hokama
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Hitoshi Matsuo
- Department of Cardiovascular Medicine. Gifu Heart Center, Gifu, Japan
| | - Nobuhiro Tanaka
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
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Pan W, Wei W, Hu Y, Feng L, Ren Y, Li X, Li C, Jiang J, Xiang J, Leng X, Yin D. Diagnostic accuracy of a novel optical coherence tomography-based fractional flow reserve algorithm for assessment of coronary stenosis significance. Cardiol J 2023:VM/OJS/J/90744. [PMID: 37964647 DOI: 10.5603/cj.90744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 03/18/2023] [Accepted: 10/15/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND This study aimed to introduce a novel optical coherence tomography-derived fractional flow reserve (FFR) computational approach and assess the diagnostic performance of the algorithm for assessing physiological function. METHODS The fusion of coronary optical coherence tomography and angiography was used to generate a novel FFR algorithm (AccuFFRoct) to evaluate functional ischemia of coronary stenosis. In the current study, a total of 34 consecutive patients were included, and AccuFFRoct was used to calculate the FFR for these patients. With the wire-measured FFR as the reference standard, we evaluated the performance of our approach by accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). RESULTS Per vessel accuracy, sensitivity, specificity, PPV, and NPV for AccuFFRoct in identifying hemodynamically significant coronary stenosis were 93.8%, 94.7%, 92.3%, 94.7%, and 92.3%, respectively, were found. Good correlation (Pearson's correlation coefficient r = 0.80, p < 0.001) between AccuFFRoct and FFR was observed. The Bland-Altman analysis showed a mean difference value of -0.037 (limits of agreement: -0.189 to 0.115). The area under the receiver-operating characteristic curve (AUC) of AccuFFRoct in identifying physiologically significant stenosis was 0.94, which was higher than the minimum lumen area (MLA, AUC = 0.91) and significantly higher than the diameter stenosis (%DS, AUC = 0.78). CONCLUSIONS This clinical study shows the efficiency and accuracy of AccuFFRoct for clinical implementation when using invasive FFR measurement as a reference. It could provide important insights into coronary imaging superior to current methods based on the degree of coronary artery stenosis.
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Affiliation(s)
- Weili Pan
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Wenjuan Wei
- Department of Cardiology, The First People's Hospital of Xiaoshan District, Hangzhou, China
| | - Yumeng Hu
- ArteryFlow Technology Co., Ltd., Hangzhou, China.
| | - Li Feng
- ArteryFlow Technology Co., Ltd., Hangzhou, China
| | - Yongkui Ren
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xinsheng Li
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Changling Li
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jun Jiang
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | | | | | - Da Yin
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
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Narula J. Coronary Anatomy, Physiology, and Beyond…. JACC Cardiovasc Imaging 2023; 16:1465-1468. [PMID: 37940325 DOI: 10.1016/j.jcmg.2023.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 08/03/2023] [Indexed: 11/10/2023]
Affiliation(s)
- Jagat Narula
- University of Texas Health Sciences Center, Houston, Texas, USA.
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Singh A, Donnino R, Small A, Bangalore S. Anomalous right coronary artery originating from the opposite sinus of Valsalva: Fractional flow reserve and intravascular ultrasound-guided management. Catheter Cardiovasc Interv 2023; 102:892-895. [PMID: 37724846 DOI: 10.1002/ccd.30839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 08/16/2023] [Accepted: 08/31/2023] [Indexed: 09/21/2023]
Abstract
There remains significant controversy in the risk stratification and management of patients with anomalous right coronary artery originating from the opposite sinus (R-ACAOS). We present the case of a patient with an inferior ST-elevation myocardial infarction, found to have R-ACAOS and severe atherosclerotic right coronary artery disease, treated with fractional flow reserve and intravascular ultrasound-guided percutaneous coronary intervention.
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Affiliation(s)
- Arushi Singh
- Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine, New York, New York, USA
| | - Robert Donnino
- Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine, New York, New York, USA
- Division of Cardiology, Veteran Affairs, Manhattan Campus, New York, New York, USA
- Department of Radiology, NYU Grossman School of Medicine, New York, New York, USA
| | - Adam Small
- Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine, New York, New York, USA
| | - Sripal Bangalore
- Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine, New York, New York, USA
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Stanojević Pirković M, Pavić O, Filipović F, Saveljić I, Geroski T, Exarchos T, Filipović N. Fractional Flow Reserve-Based Patient Risk Classification. Diagnostics (Basel) 2023; 13:3349. [PMID: 37958245 PMCID: PMC10647362 DOI: 10.3390/diagnostics13213349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/14/2023] [Accepted: 10/19/2023] [Indexed: 11/15/2023] Open
Abstract
Cardiovascular diseases (CVDs) are a leading cause of death. If not treated in a timely manner, cardiovascular diseases can cause a plethora of major life complications that can include disability and a loss of the ability to work. Globally, acute myocardial infarction (AMI) is responsible for about 3 million deaths a year. The development of strategies for prevention, but also the early detection of cardiovascular risks, is of great importance. The fractional flow reserve (FFR) is a measurement used for an assessment of the severity of coronary artery stenosis. The goal of this research was to develop a technique that can be used for patient fractional flow reserve evaluation, as well as for the assessment of the risk of death via gathered demographic and clinical data. A classification ensemble model was built using the random forest machine learning algorithm for the purposes of risk prediction. Referent patient classes were identified by the observed fractional flow reserve value, where patients with an FFR higher than 0.8 were viewed as low risk, while those with an FFR lower than 0.8 were identified as high risk. The final classification ensemble achieved a 76.21% value of estimated prediction accuracy, thus achieving a mean prediction accuracy of 74.1%, 77.3%, 78.1% and 83.6% over the models tested with 5%, 10%, 15% and 20% of the test samples, respectively. Along with the machine learning approach, a numerical approach was implemented through a 3D reconstruction of the coronary arteries for the purposes of stenosis monitoring. Even with a small number of available data points, the proposed methodology achieved satisfying results. However, these results can be improved in the future through the introduction of additional data, which will, in turn, allow for the utilization of different machine learning algorithms.
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Affiliation(s)
| | - Ognjen Pavić
- Institute for Information Technologies, University of Kragujevac, 34000 Kragujevac, Serbia; (O.P.); (I.S.)
- Bioengineering Research and Development Center (BioIRC), 34000 Kragujevac, Serbia; (F.F.); (T.G.)
| | - Filip Filipović
- Bioengineering Research and Development Center (BioIRC), 34000 Kragujevac, Serbia; (F.F.); (T.G.)
| | - Igor Saveljić
- Institute for Information Technologies, University of Kragujevac, 34000 Kragujevac, Serbia; (O.P.); (I.S.)
- Bioengineering Research and Development Center (BioIRC), 34000 Kragujevac, Serbia; (F.F.); (T.G.)
| | - Tijana Geroski
- Bioengineering Research and Development Center (BioIRC), 34000 Kragujevac, Serbia; (F.F.); (T.G.)
- Faculty of Engineering, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Themis Exarchos
- Department of Informatics, Ionian University, 49100 Corfu, Greece;
| | - Nenad Filipović
- Bioengineering Research and Development Center (BioIRC), 34000 Kragujevac, Serbia; (F.F.); (T.G.)
- Faculty of Engineering, University of Kragujevac, 34000 Kragujevac, Serbia
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