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Chen H, Hong L, Xi G, Wang H, Hu J, Liu Q, Yang L. Prognostic value of quantitative flow ratio in patients with coronary heart disease after percutaneous coronary intervention therapy: a meta-analysis. Front Cardiovasc Med 2023; 10:1164290. [PMID: 37608814 PMCID: PMC10441770 DOI: 10.3389/fcvm.2023.1164290] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 07/24/2023] [Indexed: 08/24/2023] Open
Abstract
Background Coronary atherosclerotic heart disease is one of the most serious health and life-threatening diseases. There is no doubt that despite the increasing number of assessment methods used clinically, the prognosis assessment is still not ideal, and newer assessment methods are needed. Objective To investigate the predictive value of quantitative flow ratio (QFR) for adverse events (vessel-oriented composite endpoint events/target lesion failure) in patients after percutaneous coronary intervention (PCI). Method Eight studies involving 4,173 patients (5,688 vascular lesions) were included. These are studies on the relationship between QFR values and prognosis of adverse cardiac events after PCI. This meta-analysis was performed after quality assessment and data extraction of clinical trials data that met the inclusion criteria. Result Each of the eight studies described the cut-off values for the best predictive ability of post-PCI QFR and the hazard ratio (HR) between QFR values and adverse events, respectively. The pooled HR of these studies was 4.72 (95% CI: 3.29-6.75). Concurrently, lower post-PCI QFR values were associated with the occurrence of individual clinical events (cardiac death/myocardial infarction/target vessel revascularization), with relative risk values of 6.51 (95% CI: 4.96-8.53), 4.83 (95% CI: 3.08-7.57), and 4.21 (95% CI: 2.66-6.68), respectively. Conclusion QFR may have great potential in the assessment of prognosis. It is necessary to measure QFR value after PCI. A lower QFR value after PCI was an important predictor for experiencing adverse events.
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Affiliation(s)
- Huaigang Chen
- Medical College of Nanchang University, Nanchang, China
- Department of Cardiology, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Lang Hong
- Department of Cardiology, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Gang Xi
- Department of Cardiology, The Third People's Hospital of Jingdezhen, Jingdezhen, China
| | - Hong Wang
- Department of Cardiology, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Jing Hu
- Department of Cardiology, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Qi Liu
- Medical College of Nanchang University, Nanchang, China
- Department of Cardiology, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Liu Yang
- Department of Cardiology, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
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Kumar A, Gogas BD, Thompson EW, Burnett GM, Molony D, Hosseini H, Chandran K, Lefieux A, Honda Y, Lee JM, Serruys PW, Kereiakes DJ, Stone GW, Samady H. Bioresorbable vascular scaffolds versus everolimus-eluting stents: a biomechanical analysis of the ABSORB III Imaging substudy. EUROINTERVENTION 2020; 16:e989-e996. [PMID: 32091401 DOI: 10.4244/eij-d-19-01128] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The Absorb bioresorbable vascular scaffold (BVS) has high rates of target lesion failure (TLF) at three years. Low wall shear stress (WSS) promotes several mechanisms related to device TLF. We investigated the impact of BVS compared to XIENCE V (XV) on coronary WSS after device deployment. METHODS AND RESULTS In the prospective, randomised, controlled ABSORB III Imaging study (BVS [n=77] or XV [n=36]), computational fluid dynamics were performed on fused angiographic and intravascular ultrasound (IVUS) images of post-implanted vessels. Low WSS was defined as <1 Pa. There were no differences in demographics, clinical risks, angiographic reference vessel diameter or IVUS minimal lumen diameter between BVS and XV patients. A greater proportion of vessels treated with BVS compared to XV demonstrated low WSS across the whole device (BVS: 17/77 [22%] vs XV: 2/36 [6%], p<0.029). Compared to XV, BVS demonstrated lower median circumferential WSS (1.73 vs 2.21 Pa; p=0.036), outer curvature WSS (p=0.026), and inner curvature WSS (p=0.038). Similarly, BVS had lower proximal third WSS (p=0.024), middle third WSS (p=0.047) and distal third WSS (p=0.028) when compared to XV. In a univariable logistic regression analysis, patients who received BVS were 4.8 times more likely to demonstrate low WSS across the scaffold/stent when compared to XV patients. Importantly, in a multivariable linear regression model, hypertension (beta: 0.186, p=0.023), lower contrast frame count velocity (beta: -0.411, p<0.001), lower post-stent residual plaque burden (beta: -0.338, p<0.001), lower % underexpanded frames (beta: -0.170, p=0.033) and BVS deployment (beta: 0.251, p=0.002) remained independently associated with a greater percentage of stented coronary vessel areas exposed to low WSS. CONCLUSIONS In this randomised controlled study, the Absorb BVS was 4.8 times more likely than the XV metallic stent to demonstrate low WSS. BVS implantation, lower blood velocity and lower residual post-stent plaque burden were independently associated with greater area of low WSS.
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Affiliation(s)
- Arnav Kumar
- Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, GA, USA
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Pellicano M, Di Gioia G, Ciccarelli G, Xaplanteris P, Delrue L, Toth GG, Van Durme F, Heyse A, Wyffels E, Vanderheyden M, Bartunek J, De Bruyne B, Barbato E. Procedural microvascular activation in long lesions treated with bioresorbable vascular scaffolds or everolimus-eluting stents: the PROACTIVE trial. EUROINTERVENTION 2020; 16:e147-e154. [PMID: 31085503 DOI: 10.4244/eij-d-18-01138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Significant platelet activation after long stented coronary segments has been associated with periprocedural microvascular impairment and myonecrosis. In long lesions treated either with an everolimus-eluting bioresorbable vascular scaffold (BVS) or an everolimus-eluting stent (EES), we aimed to investigate (a) procedure-related microvascular impairment, and (b) the relationship of platelet activation with microvascular function and related myonecrosis. METHODS AND RESULTS Patients (n=66) undergoing elective percutaneous coronary intervention (PCI) in long lesions were randomised 1:1 to either BVS or EES. The primary endpoint was the difference between groups in changes of pressure-derived corrected index of microvascular resistance (cIMR) after PCI. Periprocedural myonecrosis was assessed by high-sensitivity cardiac troponin T (hs-cTnT), platelet reactivity by high-sensitivity adenosine diphosphate (hs-ADP)-induced platelet reactivity with the Multiplate Analyzer. Post-dilatation was more frequent in the BVS group, with consequent longer procedure time. A significant difference was observed between the two groups in the primary endpoint of ΔcIMR (p=0.04). hs-ADP was not different between the groups at different time points. hs-cTnT significantly increased after PCI, without difference between the groups. CONCLUSIONS In long lesions, BVS implantation is associated with significant acute reduction in IMR as compared with EES, with no significant interaction with platelet reactivity or periprocedural myonecrosis.
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Shen X, Jiang J, Zhu H, Lu K, Dong P, Gu L. Comparative study of tapered versus conventional cylindrical balloon for stent implantation in stenotic tapered artery. Artif Organs 2020; 44:727-735. [DOI: 10.1111/aor.13661] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 12/17/2019] [Accepted: 01/30/2020] [Indexed: 12/24/2022]
Affiliation(s)
- Xiang Shen
- School of Mechanical Engineering Jiangsu University Zhenjiang China
| | - Jiabao Jiang
- School of Mechanical Engineering Jiangsu University Zhenjiang China
| | - Hongfei Zhu
- School of Mechanical Engineering Jiangsu University Zhenjiang China
| | - Kaikai Lu
- School of Mechanical Engineering Jiangsu University Zhenjiang China
| | - Pengfei Dong
- Department of Mechanical Engineering University of Nebraska-Lincoln Lincoln NE USA
| | - Linxia Gu
- Department of Mechanical Engineering University of Nebraska-Lincoln Lincoln NE USA
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Tenekecioglu E, Torii R, Bourantas CV, Cavalcante R, Sotomi Y, Zeng Y, Collet C, Crake T, Abizaid A, Onuma Y, Su S, Santoso T, Serruys PW. Hemodynamic analysis of a novel bioresorbable scaffold in porcine coronary artery model. Catheter Cardiovasc Interv 2018; 91:1084-1091. [PMID: 28843033 DOI: 10.1002/ccd.27253] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 07/04/2017] [Accepted: 07/22/2017] [Indexed: 11/11/2022]
Abstract
BACKGROUND The shear stress distribution assessment can provide useful insights for the hemodynamic performance of the implanted stent/scaffold. Our aim was to investigate the effect of a novel bioresorbable scaffold, Mirage on local hemodynamics in animal models. METHOD The main epicardial coronary arteries of 7 healthy mini-pigs were implanted with 11 Mirage Microfiber sirolimus-eluting Bioresorbable Scaffolds (MMSES). Optical coherence tomography (OCT) was performed post scaffold implantation and the obtained images were fused with angiographic data to reconstruct the coronary artery anatomy. Blood flow simulation was performed and Endothelial Shear Stress(ESS) distribution was estimated for each of the 11 scaffolds. ESS data were extracted in each circumferential 5-degree subunit of each cross-section in the scaffolded segment. The generalized linear mixed-effect analysis was implemented for the comparison of ESS in two scaffold groups; 150-µm strut thickness MMSES and 125-µm strut thickness MMSES. RESULTS ESS was significantly higher in MMSES (150 µm) [0.85(0.49-1.40) Pa], compared to MMSES (125 µm) [0.68(0.35-1.18) Pa]. Both MMSES (150 µm) and MMSES (125 µm) revealed low recirculation zone percentages per luminal surface area [3.17% ± 1.97% in MMSES (150 µm), 2.71% ± 1.32% in MMSES (125 µm)]. CONCLUSION Thinner strut Mirage scaffolds induced lower shear stress due to the small size vessels treated as compared to the thick strut version of the Mirage which was implanted in relatively bigger size vessels. Vessel size should be taken into account in planning BRS implantation. Small vessels may not get benefit from BRS implantation even with a streamlined strut profile. This pilot study warrants comparative assessment with commercially available bioresorbable scaffolds.
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Affiliation(s)
- Erhan Tenekecioglu
- Department of Interventional Cardiology, Erasmus University Medical Center, Thoraxcenter, Rotterdam, The Netherlands
| | - Ryo Torii
- Department of Mechanical Engineering, University College London, London, United Kingdom
| | - Christos V Bourantas
- Department of Cardiology, University College of London Hospitals, London, United Kingdom
| | - Rafael Cavalcante
- Department of Interventional Cardiology, Erasmus University Medical Center, Thoraxcenter, Rotterdam, The Netherlands
| | - Yohei Sotomi
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Yaping Zeng
- Department of Interventional Cardiology, Erasmus University Medical Center, Thoraxcenter, Rotterdam, The Netherlands
| | - Carlos Collet
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Tom Crake
- Department of Cardiology, University College of London Hospitals, London, United Kingdom
| | - Alexandre Abizaid
- Department of Invasive Cardiology, Institute Dante Pazzanese of Cardiology, São Paulo, Brazil
| | - Yoshinobu Onuma
- Department of Interventional Cardiology, Erasmus University Medical Center, Thoraxcenter, Rotterdam, The Netherlands
| | | | - Teguh Santoso
- Department of Internal Medicine, Faculty of Medicine, Dr. Cipto Mangunkusumo and Medistra Hospitals, University of Indonesia, Jakarta, Indonesia
| | - Patrick W Serruys
- Department of Interventional Cardiology, Erasmus University Medical Center, Thoraxcenter, Rotterdam, The Netherlands.,Department of Cardiology, International Centre for Circulatory Health, Imperial College, London, United Kingdom
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Maes F, Costerousse O, Cieza T, Henry M, Déry JP, Barbeau G, Delarochellière R, Paradis JM, Larose E, Nguyen CM, Pirlet C, Mongrain R, Bertrand OF. Transradial experience with bioresorbable vascular scaffolds: A case-matched study with metallic drug-eluting stents. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 19:700-704. [PMID: 29398632 DOI: 10.1016/j.carrev.2018.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 12/22/2017] [Accepted: 01/03/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Whether polymeric bioresorbable vascular scaffolds (BVS) implantation with transradial approach is feasible and safe is unknown. We compared the feasibility and safety of the transradial approach for BVS delivery with metallic drug-eluting stents (DES). METHODS We identified 118 consecutive patients who underwent BVS implantation and we compared 30-days and 1-year results with 118 matched patients with DES. Patients were matched for age, sex, risk factors and clinical indication. RESULTS Rates of transradial approach were 98% in the BVS group vs 95% in the DES group (P = 0.16) with 5Fr used in 38% and 32% (P = 0.34), respectively. The number of stents was similar in both groups, 2.6 ± 1.5 vs 2.4 ± 1.3 (P = 0.23). Although maximal pressure for stent deployment was identical in both groups (16 ± 3 atm), more lesions were pre-dilated (83% vs 52%, P < 0.001) and post-dilated (71% vs 33%, P < 0.001) in the BVS group. Contrast volume (217 ± 97 vs 175 ± 108 ml, P < 0.001), fluoroscopy time (16 [10-23] vs 13 [8-21] min, P = 0.04) and procedure duration (65 ± 31 vs 56 ± 47 min, P = 0.045) were significantly higher in the BVS group. Major adverse cardiac events, including death, myocardial infarction and target vessel revascularization remained similar in both groups, 1.7% vs 0.8% (P = 0.56) at 30 days and 10% vs 8.5% (P = 0.66) at 1 year. At 1 year, stent thrombosis occurred in 2 (1.7%) patients in the BVS group and 1 (0.8%) patient in the DES group (P = 0.56). CONCLUSION The use of transradial approach for BVS compared to DES implantation was feasible and safe in all-comers, although BVS implantation included more technical challenges. Outcomes up to 1-year remained comparable in both groups.
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Affiliation(s)
- Frédéric Maes
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
| | - Olivier Costerousse
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
| | - Tomas Cieza
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
| | - Mélaine Henry
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
| | - Jean-Pierre Déry
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
| | - Gérald Barbeau
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
| | | | - Jean-Michel Paradis
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
| | - Eric Larose
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
| | - Can M Nguyen
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
| | - Charles Pirlet
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
| | - Rosaire Mongrain
- Department of Mechanical Engineering, McGill University, Montréal, Canada
| | - Olivier F Bertrand
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada; Department of Mechanical Engineering, McGill University, Montréal, Canada.
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Chiastra C, Migliori S, Burzotta F, Dubini G, Migliavacca F. Patient-Specific Modeling of Stented Coronary Arteries Reconstructed from Optical Coherence Tomography: Towards a Widespread Clinical Use of Fluid Dynamics Analyses. J Cardiovasc Transl Res 2017; 11:156-172. [PMID: 29282628 PMCID: PMC5908818 DOI: 10.1007/s12265-017-9777-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 12/18/2017] [Indexed: 11/30/2022]
Abstract
The recent widespread application of optical coherence tomography (OCT) in interventional cardiology has improved patient-specific modeling of stented coronary arteries for the investigation of local hemodynamics. In this review, the workflow for the creation of fluid dynamics models of stented coronary arteries from OCT images is presented. The algorithms for lumen contours and stent strut detection from OCT as well as the reconstruction methods of stented geometries are discussed. Furthermore, the state of the art of studies that investigate the hemodynamics of OCT-based stented coronary artery geometries is reported. Although those studies analyzed few patient-specific cases, the application of the current reconstruction methods of stented geometries to large populations is possible. However, the improvement of these methods and the reduction of the time needed for the entire modeling process are crucial for a widespread clinical use of the OCT-based models and future in silico clinical trials.
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Affiliation(s)
- Claudio Chiastra
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133, Milan, Italy.
| | - Susanna Migliori
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133, Milan, Italy
| | - Francesco Burzotta
- Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
| | - Gabriele Dubini
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133, Milan, Italy
| | - Francesco Migliavacca
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133, Milan, Italy
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Katagiri Y, Tenekecioglu E, Serruys PW, Collet C, Katsikis A, Asano T, Miyazaki Y, Piek JJ, Wykrzykowska JJ, Bourantas C, Onuma Y. What does the future hold for novel intravascular imaging devices: a focus on morphological and physiological assessment of plaque. Expert Rev Med Devices 2017; 14:985-999. [DOI: 10.1080/17434440.2017.1407646] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Yuki Katagiri
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | | | - Carlos Collet
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Athanasios Katsikis
- Department of Cardiology, General Military Hospital of Athens, Athens, Greece
| | - Taku Asano
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Yosuke Miyazaki
- ThoraxCenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jan J Piek
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Christos Bourantas
- Barts Heart Centre, Barts Health NHS Trust, London, UK
- Institute of Cardiovascular Sciences, University College London, London, UK
| | - Yoshinobu Onuma
- ThoraxCenter, Erasmus Medical Center, Rotterdam, The Netherlands
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Sotomi Y, Suwannasom P, Tenekecioglu E, Collet C, Nakatani S, Okamura T, Muramatsu T, Ishibashi Y, Tateishi H, Miyazaki Y, Asano T, Katagiri Y, von zur Muehlen C, Tanabe K, Kozuma K, Ozaki Y, Serruys PW, Onuma Y. Imaging assessment of bioresorbable vascular scaffolds. Cardiovasc Interv Ther 2017; 33:11-22. [DOI: 10.1007/s12928-017-0486-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 07/26/2017] [Indexed: 10/19/2022]
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10
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The effect of strut thickness on shear stress distribution in a preclinical model. Int J Cardiovasc Imaging 2017; 33:1675-1676. [PMID: 28567706 PMCID: PMC5682860 DOI: 10.1007/s10554-017-1173-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Accepted: 05/17/2017] [Indexed: 10/25/2022]
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