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Santos LDM, Campos CM, Garcia-Garcia HM, Godinho RR, Lopes MAAM, Seleme VB, Côrtes RS, Mendes GDAC, Rosa VEE, Lopes NHM, de Brito Junior FS, Abizaid AAC. Concordance between vessel-specific and vascular territory coronary functional assessment: A comparison of quantitative flow ratio and myocardial perfusion scintigraphy. Catheter Cardiovasc Interv 2024. [PMID: 38558510 DOI: 10.1002/ccd.31021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 02/14/2024] [Accepted: 03/19/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Quantitative flow ratio (QFR) and myocardial perfusion scintigraphy (MPS) are utilized for assessing coronary artery disease (CAD) significance. We aimed to analyze their concordance and prognostic impact. AIMS We aimed to analyze the concordance between QFR and MPS and their risk stratification. METHODS Patients with invasive coronary angiography and MPS were categorized as concordant if QFR ≤ 0.80 and summed difference score (SDS) ≥ 4 or if QFR > 0.80 and SDS < 4; otherwise, they were discordant. Concordance was classified by coronary territory involvement: total (three territories), partial (two territories), poor (one territory), and total discordance (zero territories). Leaman score assessed coronary atherosclerotic burden. RESULTS 2010 coronary territories (670 patients) underwent joint QFR and MPS analysis. MPS area under the curve for QFR ≤ 0.80 was 0.637. Concordance rates were total (52.5%), partial (29.1%), poor (15.8%), and total discordance (2.6%). Most concordance occurred in patients without significant CAD or with single-vessel disease (89.5%), particularly without MPS perfusion defects (91.5%). Leaman score (odds ratio [OR]: 0.839, 95% confidence interval [CI]: 0.805-0.875, p < 0.001) and MPS perfusion defect (summed stress score [SSS] ≥ 4) (OR: 0.355, 95% CI: 0.211-0.596, p < 0.001) were independent predictors for discordance. After 1400 days, no significant difference in death/myocardial infarction was observed based on MPS assessment, but Leaman score, functional Leaman score, and average QFR identified higher risk patients. CONCLUSIONS MPS showed good overall accuracy in assessing QFR significance but substantial discordance existed. Predictors for discordance included higher atherosclerotic burden and MPS perfusion defects (SSS ≥ 4). Leaman score, QFR-based functional Leaman score, and average QFR provided better risk stratification for all-cause death and myocardial infarction than MPS.
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Affiliation(s)
- Luciano de Moura Santos
- Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil
- Department of Interventional Cardiology, Hospital Santa Lucia, Brasilia, Brazil
| | - Carlos M Campos
- Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil
- Instituto Prevent Senior, Sao Paulo, Brazil
| | - Hector Manuel Garcia-Garcia
- Instituto Prevent Senior, Sao Paulo, Brazil
- Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | | | | | | | - Rafael Silva Côrtes
- Department of Interventional Cardiology, Hospital Santa Lucia, Brasilia, Brazil
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Chen M, Liu J, Xie Z, Chen W, Hu Y, Wen J, Chen J, Chen X, Lin L, Wang R, Lu L. Effect of hemoglobin A1c management levels on coronary physiology evaluated by quantitative flow ratio in patients who underwent percutaneous coronary intervention. J Diabetes Investig 2024; 15:336-345. [PMID: 38009857 PMCID: PMC10906016 DOI: 10.1111/jdi.14114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 10/18/2023] [Accepted: 11/10/2023] [Indexed: 11/29/2023] Open
Abstract
AIMS/INTRODUCTION The coronary physiology and prognosis of patients with different hemoglobin A1c (HbA1c) levels after percutaneous coronary intervention (PCI) are currently unknown. The aim of this study was to assess the effect of different levels of HbA1c control on coronary physiology in patients who underwent PCI for coronary heart disease combined with type 2 diabetes mellitus by quantitative flow ratio (QFR). MATERIALS AND METHODS Patients who successfully underwent PCI and completed 1-year coronary angiographic follow up were enrolled, clinical data were collected, and QFR at immediate and 1-year follow up after PCI was retrospectively analyzed. A total of 257 patients (361 vessels) were finally enrolled and divided into the hemoglobin A1c (HbA1c)-compliance group (103 patients, 138 vessels) and non-HbA1c-compliance group (154 patients, 223 vessels) according to the HbA1c cut-off value of 7%. We compared the results of QFR analysis and clinical outcomes between the two groups. RESULTS At 1-year follow up after PCI, the QFR was significantly higher (0.94 ± 0.07 vs 0.92 ± 0.10, P = 0.019) and declined less (0.014 ± 0.066 vs 0.033 ± 0.095, P = 0.029) in the HbA1c-compliance group. Meanwhile, the incidence of physiological restenosis was lower in the HbA1c-compliance group (2.9% vs 8.5%, P = 0.034). Additionally, the target vessel revascularization rate was lower in the HbA1c-compliance group (6.8% vs 16.9%, P = 0.018). Furthermore, HbA1c ≥7% (OR 2.113, 95% confidence interval 1.081-4.128, P = 0.029) and QFR decline (OR 2.215, 95% confidence interval 1.147-4.277, P = 0.018) were independent risk factors for target vessel revascularization. CONCLUSION Patients with well-controlled HbA1c levels have better coronary physiological benefits and the incidence of adverse clinical outcome events might be reduced.
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Affiliation(s)
- Mingfeng Chen
- Department of CardiologyFujian Provincial HospitalFuzhouChina
| | - Jichen Liu
- Shengli Clinical Medical College of Fujian Medical UniversityFuzhouChina
| | - Zhangxin Xie
- Shengli Clinical Medical College of Fujian Medical UniversityFuzhouChina
- Department of EmergencyFujian Provincial HospitalFuzhouChina
- Fujian Provincial Key Laboratory of Emergency Medicine, Fujian Emergency Medical CenterFujian Provincial Institute of Emergency MedicineFuzhouChina
| | - Wei Chen
- Department of CardiologyFujian Provincial HospitalFuzhouChina
- Shengli Clinical Medical College of Fujian Medical UniversityFuzhouChina
| | - Yanqin Hu
- Shengli Clinical Medical College of Fujian Medical UniversityFuzhouChina
| | - Junping Wen
- Shengli Clinical Medical College of Fujian Medical UniversityFuzhouChina
- Department of EndocrinologyFujian Provincial HospitalFuzhouChina
| | - Jinyan Chen
- Institute for Immunology, Fujian Academy of Medical SciencesFuzhouChina
| | - Xuemei Chen
- Shengli Clinical Medical College of Fujian Medical UniversityFuzhouChina
- Department of Critical Care MedicineFujian Provincial Hospital, Fujian Provincial Center for Critical Care MedicineFuzhouChina
| | - Lirong Lin
- Department of CardiologyFujian Provincial HospitalFuzhouChina
- Shengli Clinical Medical College of Fujian Medical UniversityFuzhouChina
| | - Rehua Wang
- Department of CardiologyFujian Provincial HospitalFuzhouChina
- Shengli Clinical Medical College of Fujian Medical UniversityFuzhouChina
| | - Lihong Lu
- Department of CardiologyFujian Provincial HospitalFuzhouChina
- Shengli Clinical Medical College of Fujian Medical UniversityFuzhouChina
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Zhao Q, Sun S, Zhou F, Yue J, Luo X, Qu X. The Inhibition of Evolocumab on Non-Infarct-Related Artery Disease in Patients with ST-Elevation Myocardial Infarction. Int J Gen Med 2023; 16:2771-2781. [PMID: 37408846 PMCID: PMC10319277 DOI: 10.2147/ijgm.s417481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 06/26/2023] [Indexed: 07/07/2023] Open
Abstract
Purpose The effects of combing evolocumab and statin on the clinical outcome and physiological function of coronary arteries in STEMI patients with non-infarct-related artery (NIRA) disease are still unclear. Methods A total of 355 STEMI patients with NIRA were enrolled in this study, who underwent combined quantitative flow ratio (QFR) at baseline and after 12 months of treatment with statin monotherapy or statin plus evolocumab. Results Diameter stenosis and lesion length were significantly lower in the group undergoing statin plus evolocumab. While the group exhibited significantly higher minimum lumen diameter (MLD), and QFR values. Statin plus evolocumab (OR = 0.350; 95% CI: 0.149-0.824; P = 0.016) and plaque lesion length (OR = 1.223; 95% CI: 1.102-1.457; P = 0.033) were independently associated with rehospitalization for unstable angina (UA) within 12 months. Conclusion Evolocumab combined with statin therapy can significantly improve the anatomical and physiological function of the coronary arteries and downregulate the re-hospitalization rate due to UA in STEMI patients with NIRA.
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Affiliation(s)
- Qi Zhao
- Department of Cardiology, 1st Affiliated Hospital of Harbin Medical University, Harbin, 150086, People’s Republic of China
| | - Siyuan Sun
- Department of Cardiology, People’s Hospital of Taihe County, Taihe, Anhui, 236600, People’s Republic of China
| | - Fanghui Zhou
- Department of Hematology, 2nd Affiliated Hospital of Harbin Medical University, Harbin, 150001, People’s Republic of China
| | - Jingkun Yue
- Department of Cardiology, People’s Hospital of Taihe County, Taihe, Anhui, 236600, People’s Republic of China
| | - Xing Luo
- Department of Cardiology, 2nd Affiliated Hospital of Harbin Medical University, Harbin, 150001, People’s Republic of China
| | - Xiufen Qu
- Department of Cardiology, 1st Affiliated Hospital of Harbin Medical University, Harbin, 150086, People’s Republic of China
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Wang Y, Jiao H, Peng H, Liu J, Ma L, Wang J. Study of Vertebral Artery Dissection by Ultrasound Superb Microvascular Imaging Based on Deep Neural Network Model. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:9713899. [PMID: 35256903 PMCID: PMC8898129 DOI: 10.1155/2022/9713899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/14/2021] [Accepted: 12/21/2021] [Indexed: 12/04/2022]
Abstract
To assess the diagnostic value of ultrasound Superb Microvascular Imaging (SMI) and versus Doppler ultrasound (TCD) for microvascular structure and aerodynamic changes in vertebral artery dissection (VAD). In this paper, we firstly simulate the process of clinician recognition of vertebral artery dissection and propose a combination of a priori shape information of vertebral artery dissection and deep folly convolutional networks (DFCNs) for IVUS. In this paper, 15 patients with vertebral artery dissection confirmed by SMI, digital subtraction angiography (DSA), or computed tomography angiography (CTA) from 2020 to 2021 were selected, and the true and false lumen diameters, peak systolic flow velocity (PSV), end-diastolic flow velocity (EDV) and PSV, EDV, and plasticity index (PI) of the intracranial vertebral artery were measured. Among the 15 patients with VAD, 4 (27%, 4/15) had trauma-induced secondary vertebral artery entrapment and 11 (73%, 11/15) had spontaneous entrapment without a clear cause. According to the structural characteristics of the vessels, there were 11 cases (73%, 11/15) of double-lumen, intramural hematoma, and vertebral artery dissection aneurysm, and 11 cases (73%, 11/15) of V1 segment. SMI not only provides an objective assessment of the vascular morphology and aerodynamic changes in VAD but also, in combination with TCD, can further determine the opening of the traffic branches in the posterior circulation, providing reliable information for the early diagnosis and treatment of microvascular dissection of the vertebral artery.
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Affiliation(s)
- Yanjuan Wang
- Department of Ultrasound, General Hospital of Ningxia Medical University, Yinchuan, NingXia 750001, China
| | - Huajie Jiao
- Department of Medical Imaging, Ningxia People's Hospital, Yinchuan, NingXia 750001, China
| | - Huihui Peng
- Department of Ultrasound, General Hospital of Ningxia Medical University, Yinchuan, NingXia 750001, China
| | - Jinfang Liu
- Department of Neurology, General Hospital of Ningxia Medical University, Yinchuan, NingXia 750001, China
| | - Liyuan Ma
- Department of Ultrasound, General Hospital of Ningxia Medical University, Yinchuan, NingXia 750001, China
| | - Jianjun Wang
- Department of Ultrasound, General Hospital of Ningxia Medical University, Yinchuan, NingXia 750001, China
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Ye Z, Chen Q, Zhong J, Chen L, Chen L, Ye M, Yan Y, Chen L, Luo Y. Impact of diabetes on coronary physiology evaluated by quantitative flow ratio in patients who underwent percutaneous coronary intervention. J Diabetes Investig 2022; 13:1203-1212. [PMID: 35199479 PMCID: PMC9248432 DOI: 10.1111/jdi.13779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 01/13/2022] [Accepted: 02/20/2022] [Indexed: 11/28/2022] Open
Abstract
Aims/Introduction There are mixed opinions on the influence of diabetes on the prognosis of patients receiving percutaneous coronary intervention (PCI). Therefore, in this study, the quantitative flow ratio (QFR), an emerging technology of functional evaluation, was used to explore the impact of diabetes on coronary physiology in patients who underwent PCI. Materials and Methods Patients who underwent successful PCI and a 1‐year angiographic follow up were retrospectively screened and analyzed by the QFR. Based on the presence or absence of diabetes, 677 enrolled patients (794 vessels) were classified into a diabetes group (211 patients, 261 vessels) and a non‐diabetes group (466 patients, 533 vessels). The results of QFR analysis and clinical outcomes were compared between the two groups. Results The two groups reached a similar level of post‐PCI QFR (0.95 ± 0.09 vs 0.96 ± 0.06, P = 0.292). However, at the 1‐year follow up, the QFR was lower (0.93 ± 0.11 vs 0.96 ± 0.07, P < 0.001), and the degree of QFR decline was more obvious (−0.024 ± 0.090 vs −0.008 ± 0.070, P = 0.023) in the diabetes group. Additionally, diabetes was independently associated with functional restenosis (odds ratio 2.164, 95% confidence interval 1.210–3.870, P = 0.009) and target vessel failure (odds ratio 2.654, 95% confidence interval 1.405–5.012, P = 0.003). Conclusion As evaluated by the QFR, patients with diabetes received less coronary physiological benefit from PCI, which was consistent with their clinical outcomes.
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Affiliation(s)
- Zhen Ye
- Department of Cardiology, Fujian Medical University Union Hospital, No. 29 Xin Quan Road, Fuzhou, Fujian, 350001, China.,Fujian Institute of Coronary Heart Disease, Fuzhou, Fujian, 350001, China.,Fujian Heart Medical Center, Fuzhou, Fujian, 350001, China
| | - Qin Chen
- Department of Cardiology, Fujian Medical University Union Hospital, No. 29 Xin Quan Road, Fuzhou, Fujian, 350001, China.,Fujian Institute of Coronary Heart Disease, Fuzhou, Fujian, 350001, China.,Fujian Heart Medical Center, Fuzhou, Fujian, 350001, China
| | - Jiaxin Zhong
- Department of Cardiology, Fujian Medical University Union Hospital, No. 29 Xin Quan Road, Fuzhou, Fujian, 350001, China.,Fujian Institute of Coronary Heart Disease, Fuzhou, Fujian, 350001, China.,Fujian Heart Medical Center, Fuzhou, Fujian, 350001, China
| | - Long Chen
- Department of Cardiology, Fujian Medical University Union Hospital, No. 29 Xin Quan Road, Fuzhou, Fujian, 350001, China.,Fujian Institute of Coronary Heart Disease, Fuzhou, Fujian, 350001, China.,Fujian Heart Medical Center, Fuzhou, Fujian, 350001, China
| | - Lihua Chen
- Department of Cardiology, Fujian Medical University Union Hospital, No. 29 Xin Quan Road, Fuzhou, Fujian, 350001, China.,Fujian Institute of Coronary Heart Disease, Fuzhou, Fujian, 350001, China.,Fujian Heart Medical Center, Fuzhou, Fujian, 350001, China
| | - Mingfang Ye
- Department of Cardiology, Fujian Medical University Union Hospital, No. 29 Xin Quan Road, Fuzhou, Fujian, 350001, China.,Fujian Institute of Coronary Heart Disease, Fuzhou, Fujian, 350001, China.,Fujian Heart Medical Center, Fuzhou, Fujian, 350001, China
| | - Yuanming Yan
- Department of Cardiology, Fujian Medical University Union Hospital, No. 29 Xin Quan Road, Fuzhou, Fujian, 350001, China.,Fujian Institute of Coronary Heart Disease, Fuzhou, Fujian, 350001, China.,Fujian Heart Medical Center, Fuzhou, Fujian, 350001, China
| | - Lianglong Chen
- Department of Cardiology, Fujian Medical University Union Hospital, No. 29 Xin Quan Road, Fuzhou, Fujian, 350001, China.,Fujian Institute of Coronary Heart Disease, Fuzhou, Fujian, 350001, China.,Fujian Heart Medical Center, Fuzhou, Fujian, 350001, China
| | - Yukun Luo
- Department of Cardiology, Fujian Medical University Union Hospital, No. 29 Xin Quan Road, Fuzhou, Fujian, 350001, China.,Fujian Institute of Coronary Heart Disease, Fuzhou, Fujian, 350001, China.,Fujian Heart Medical Center, Fuzhou, Fujian, 350001, China
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Schindler TH, Leucker TM, Bhandiwad A. Entering a new era of the identification and characterization of myocardial ischemic burden with 15O-water PET? Int J Cardiol 2021; 341:22-23. [PMID: 34329679 DOI: 10.1016/j.ijcard.2021.07.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 07/21/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Thomas H Schindler
- Mallinckrodt Institute of Radiology, Division of Nuclear Medicine, Cardiovascular Medicine, Washington University School of Medicine, St. Louis, MO, USA; Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD, USA; Cardiovascular Division, John T. Milliken Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, USA.
| | - Thorsten M Leucker
- Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD, USA
| | - Anita Bhandiwad
- Cardiovascular Division, John T. Milliken Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, USA
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Xu J, Cai F, Geng C, Wang Z, Tang X. Diagnostic Performance of CMR, SPECT, and PET Imaging for the Identification of Coronary Artery Disease: A Meta-Analysis. Front Cardiovasc Med 2021; 8:621389. [PMID: 34026862 PMCID: PMC8138058 DOI: 10.3389/fcvm.2021.621389] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 02/23/2021] [Indexed: 12/26/2022] Open
Abstract
Background: Myocardial perfusion imaging modalities, such as cardiac magnetic resonance (CMR), single-photon emission computed tomography (SPECT), and positron emission tomography (PET), are well-established non-invasive diagnostic methods to detect hemodynamically significant coronary artery disease (CAD). The aim of this meta-analysis is to compare CMR, SPECT, and PET in the diagnosis of CAD and to provide evidence for further research and clinical decision-making. Methods: PubMed, Web of Science, EMBASE, and Cochrane Library were searched. Studies that used CMR, SPECT, and/or PET for the diagnosis of CAD were included. Pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio with their respective 95% confidence interval, and the area under the summary receiver operating characteristic (SROC) curve were calculated. Results: A total of 203 articles were identified for inclusion in this meta-analysis. The pooled sensitivity values of CMR, SPECT, and PET were 0.86, 0.83, and 0.85, respectively. Their respective overall specificity values were 0.83, 0.77, and 0.86. Results in subgroup analysis of the performance of SPECT with 201Tl showed the highest pooled sensitivity [0.85 (0.82, 0.88)] and specificity [0.80 (0.75, 0.83)]. 99mTc-tetrofosmin had the lowest sensitivity [0.76 (0.67, 0.82)]. In the subgroup analysis of PET tracers, results indicated that 13N had the lowest pooled sensitivity [0.83 (0.74, 0.89)], and the specificity was the highest [0.91 (0.81, 0.96)]. Conclusion: Our meta-analysis indicates that CMR and PET present better diagnostic performance for the detection of CAD as compared with SPECT.
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Affiliation(s)
- Jianfeng Xu
- Department of Nuclear Sciences and Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China.,JYAMS PET Research and Development Limited, Nanjing, China
| | - Fei Cai
- Department of Nuclear Sciences and Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China.,JYAMS PET Research and Development Limited, Nanjing, China
| | - Changran Geng
- Department of Nuclear Sciences and Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Zheng Wang
- JYAMS PET Research and Development Limited, Nanjing, China
| | - Xiaobin Tang
- Department of Nuclear Sciences and Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China
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