1
|
Liu J, Li B, Zhang Y, Zhang L, Huang S, Sun H, Liu J, Zhao X, Zhang M, Wang W, Liu Y. A high-fidelity geometric multiscale hemodynamic model for predicting myocardial ischemia. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 233:107476. [PMID: 36933317 DOI: 10.1016/j.cmpb.2023.107476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 03/09/2023] [Accepted: 03/09/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND AND OBJECTIVES Coronary computed tomography angiography (CCTA) derived fractional flow reserve (CT-FFR) requires a maximal hyperemic state to be modeled by assuming the total coronary resistance decreased to a constant 0.24 of that under the resting state. However, this assumption neglects the vasodilator capacity of individual patients. Herein, we proposed a high-fidelity geometric multiscale model (HFMM) to characterize coronary pressure and flow under the resting state, seeking to better predict myocardial ischemia by using CCTA-derived instantaneous wave-free ratio (CT-iFR). METHODS Fifty-seven patients (62 lesions) who had undergone CCTA and were then referred to invasive FFR were prospectively enrolled. The coronary microcirculation resistance hemodynamic model (RHM) under the resting condition was established on a patient-specific basis. Coupled with a closed-loop geometric multiscale model (CGM) of their individual coronary circulations, the HFMM model was established to non-invasively derive the CT-iFR from CCTA images. RESULTS With the invasive FFR being the reference standard, accuracy of the obtained CT-iFR in identifying myocardial ischemia was greater than those of the CCTA and non-invasively derived CT-FFR (90.32% vs. 79.03% vs. 84.3%). The overall computational time of CT-iFR was 61 ± 6 min, faster than that of the CT-FFR (8 h). The sensitivity, specificity, positive predictive value, and negative predictive value of the CT-iFR in discriminating an invasive FFR > 0.8 were 78% (95% CI: 40-97%), 92% (95% CI: 82-98%), 64% (95% CI: 39-83%), and 96% (95% CI:88-99%), respectively. CONCLUSIONS A high-fidelity geometric multiscale hemodynamic model was developed for rapid and accurate estimation of CT-iFR. Compared with CT-FFR, CT-iFR is of less computational cost and enables assessment of tandem lesions.
Collapse
Affiliation(s)
- Jincheng Liu
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing, China
| | - Bao Li
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing, China
| | - Yanping Zhang
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing, China
| | - Liyuan Zhang
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing, China
| | - Suqin Huang
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing, China
| | - Hao Sun
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing, China
| | - Jian Liu
- Department of Cardiology, Peking University People's Hospital, Beijing, China
| | - Xi Zhao
- Central Research Institute, United Imaging Healthcare, Shanghai, China
| | - Mingzi Zhang
- Macquarie Medical School, Faculty of Medicine, Health, and Human Sciences, Macquarie University, Sydney, Australia
| | | | - Youjun Liu
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing, China.
| |
Collapse
|
2
|
Cwikiel J, Fagerland MW, Wachtell K, Arnesen H, Seljeflot I, Flaa A. Exercise-induced change in circulating NT-proBNP could not distinguish between patients with and without coronary artery disease: the CADENCE study. Scand Cardiovasc J Suppl 2022; 56:107-113. [PMID: 35593516 DOI: 10.1080/14017431.2022.2075562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Objective. In patients with chest pain, exercise stress test has a moderate accuracy for coronary artery disease (CAD). Adding a reliable cardiac biomarker to the exercise test could potentially improve the precision of the test. We investigated circulating NT-proBNP levels before and during exercise stress test in patients with and without angiographically verified CAD. We hypothesized that NT-proBNP would give an additive diagnostic value to the exercise stress test. Methods. In patients presenting with symptoms of stable CAD, venous blood samples were taken at rest and within 5 min of termination of a maximal stress test on a bicycle ergometer. All study participants underwent coronary angiography. Significant CAD was defined as ≥75% stenosis in one or more segments of the coronary arteries. Results. Of the 297 participants, significant CAD was found in 111 (37%) patients. Resting levels of NT-proBNP were significantly higher in patients with CAD compared with patients without CAD (74.18 vs. 56.03 ng/L), p = .005. During exercise, NT-proBNP levels increased in the total population (p < .001). The rise was, however, not significantly different between the two groups (8.24 vs. 8.51 ng/L), p = .700. Combining resting NT-proBNP with positive exercise stress test was superior to exercise test alone in predicting CAD, AUC = 0.68 vs. 0.64. Conclusion. Exercise-induced change in circulating NT-proBNP could not distinguish between patients with or without CAD. However, resting levels of NT-proBNP were significantly higher in patients with CAD than those without CAD.
Collapse
Affiliation(s)
- Joanna Cwikiel
- Center for Clinical Heart Research, Department of Cardiology, Oslo University Hospital Ullevaal, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway.,Section of Cardiovascular and Renal research, Oslo University Hospital Ulleval, Oslo, Norway
| | - Morten W Fagerland
- Oslo Centre for Biostatistics and Epidemiology, Research Support Service, Oslo University Hospital, Oslo, Norway
| | - Kristian Wachtell
- Department of Cardiology, Section for Cardiology Intervention, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Oslo, Norway
| | - Harald Arnesen
- Center for Clinical Heart Research, Department of Cardiology, Oslo University Hospital Ullevaal, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ingebjørg Seljeflot
- Center for Clinical Heart Research, Department of Cardiology, Oslo University Hospital Ullevaal, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Cardiology, Oslo University Hospital Ullevaal, Oslo, Norway
| | - Arnljot Flaa
- Section of Cardiovascular and Renal research, Oslo University Hospital Ulleval, Oslo, Norway.,Department of Cardiology, Oslo University Hospital Ullevaal, Oslo, Norway
| |
Collapse
|
3
|
Brandt V, Schoepf UJ, Aquino GJ, Bekeredjian R, Varga-Szemes A, Emrich T, Bayer RR, Schwarz F, Kroencke TJ, Tesche C, Decker JA. Impact of machine-learning-based coronary computed tomography angiography-derived fractional flow reserve on decision-making in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement. Eur Radiol 2022; 32:6008-6016. [PMID: 35359166 DOI: 10.1007/s00330-022-08758-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/17/2022] [Accepted: 03/21/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To evaluate feasibility and diagnostic performance of coronary CT angiography (CCTA)-derived fractional flow reserve (CT-FFR) for detection of significant coronary artery disease (CAD) and decision-making in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR) to potentially avoid additional pre-TAVR invasive coronary angiography (ICA). METHODS Consecutive patients with severe AS (n = 95, 78.6 ± 8.8 years, 53% female) undergoing pre-procedural TAVR-CT followed by ICA with quantitative coronary angiography were retrospectively analyzed. CCTA datasets were evaluated using CAD Reporting and Data System (CAD-RADS) classification. CT-FFR measurements were computed using an on-site machine-learning algorithm. A combined algorithm was developed for decision-making to determine if ICA is needed based on pre-TAVR CCTA: [1] all patients with CAD-RADS ≥ 4 are referred for ICA; [2] patients with CAD-RADS 2 and 3 are evaluated utilizing CT-FFR and sent to ICA if CT-FFR ≤ 0.80; [3] patients with CAD-RADS < 2 or CAD-RADS 2-3 and normal CT-FFR are not referred for ICA. RESULTS Twelve patients (13%) had significant CAD (≥ 70% stenosis) on ICA and were treated with PCI. Twenty-eight patients (30%) showed CT-FFR ≤ 0.80 and 24 (86%) of those were reported to have a maximum stenosis ≥ 50% during ICA. Using the proposed algorithm, significant CAD could be identified with a sensitivity, specificity, and positive and negative predictive value of 100%, 78%, 40%, and 100%, respectively, potentially decreasing the number of necessary ICAs by 65 (68%). CONCLUSION Combination of CT-FFR and CAD-RADS is able to identify significant CAD pre-TAVR and bears potential to significantly reduce the number of needed ICAs. KEY POINTS • Coronary CT angiography-derived fractional flow reserve (CT-FFR) using machine learning together with the CAD Reporting and Data System (CAD-RADS) classification safely identifies significant coronary artery disease based on quantitative coronary angiography in patients prior to transcatheter aortic valve replacement. • The combination of CT-FFR and CAD-RADS enables decision-making and bears the potential to significantly reduce the number of needed invasive coronary angiographies.
Collapse
Affiliation(s)
- Verena Brandt
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 5 Courtenay Drive, Charleston, SC, 29425-2260, USA
- Department of Cardiology and Angiology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 5 Courtenay Drive, Charleston, SC, 29425-2260, USA.
| | - Gilberto J Aquino
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 5 Courtenay Drive, Charleston, SC, 29425-2260, USA
| | - Raffi Bekeredjian
- Department of Cardiology and Angiology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 5 Courtenay Drive, Charleston, SC, 29425-2260, USA
| | - Tilman Emrich
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 5 Courtenay Drive, Charleston, SC, 29425-2260, USA
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany
| | - Richard R Bayer
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 5 Courtenay Drive, Charleston, SC, 29425-2260, USA
| | - Florian Schwarz
- Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany
| | - Thomas J Kroencke
- Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany
| | - Christian Tesche
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 5 Courtenay Drive, Charleston, SC, 29425-2260, USA
- Department of Cardiology, Clinic Augustinum Munich, Munich, Germany
- Department of Cardiology, Munich University Clinic, Ludwig-Maximilians-University, Munich, Germany
| | - Josua A Decker
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 5 Courtenay Drive, Charleston, SC, 29425-2260, USA
- Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany
| |
Collapse
|
4
|
Calé R. Coronary physiology in clinical practice in Portugal: A problem of technology or a question of attitude? Rev Port Cardiol 2021; 40:783-784. [PMID: 34857117 DOI: 10.1016/j.repce.2021.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Rita Calé
- Serviço de Cardiologia do Hospital Garcia de Orta, Almada, Portugal.
| |
Collapse
|
5
|
Calé R. Coronary physiology in clinical practice in Portugal: A problem of technology or a question of attitude? Rev Port Cardiol 2021; 40:S0870-2551(21)00352-8. [PMID: 34509333 DOI: 10.1016/j.repc.2021.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Rita Calé
- Serviço de Cardiologia do Hospital Garcia de Orta, Almada, Portugal.
| |
Collapse
|
6
|
Bensaid R, Georges JL, Angoulvant D, Chassaing S, Deballon R, Marcollet P, Albert F, Fichaux O, Bar O, Rangé G. INCREASED EXPOSURE TO X-RAYS DURING CORONARY ANGIOGRAPHY AND PERCUTANEOUS CORONARY INTERVENTIONS ASSOCIATED WITH FRACTIONAL FLOW RESERVE MEASUREMENT AND ENDOCORONARY IMAGING TECHNIQUES. RADIATION PROTECTION DOSIMETRY 2021; 194:18-26. [PMID: 33954788 DOI: 10.1093/rpd/ncab065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 03/09/2021] [Accepted: 04/08/2021] [Indexed: 06/12/2023]
Abstract
Growing use of fractional flow reserve (FFR) and intracoronary imaging techniques by optical coherence tomography or intravascular ultrasound has raised concerns about additional exposure during coronary angiography and percutaneous coronary interventions (PCIs). Using data from the prospective CRAC-France PCI Prospective Multicentre registry, we sought to evaluate the effect of these new techniques on the radiation dose to patients undergoing coronary procedures. Data on Kerma Area Product (PKA), total air kerma (KAr) and fluoroscopy time from 42 182 coronary procedures were retrospectively compared, using multivariable linear regression, according to whether they included FFR and intracoronary imaging. In coronary angiography, FFR was associated with longer fluoroscopy time and higher PKA (21.0 vs. 18.9 Gy.cm2) and KAr (372 vs. 299 mGy) (all p < 0.001). Intracoronary imaging was associated with longer fluoroscopy time, higher contrast volume (both p < 0.001), lower PKA (18.3 vs. 19.0 Gy.cm2, p = 0.02) and similar KAr. In PCI, FFR was associated with a moderate increase in KAr (682 vs. 626 mGy, p < 0.01) but not PKA (35.9 vs. 33.7 Gy.cm2, p = 0.34). For intracoronary imaging, there were no differences between groups, except for contrast volume. Increased patient exposure associated with FFR and intracoronary imaging is moderate in diagnostic coronary angiography and minimal or none in PCI, provided optimization techniques are used. It should not be a limitation on the use of these techniques given the important additional information they provide.
Collapse
Affiliation(s)
- Réda Bensaid
- Cardiology Department, Les Hôpitaux de Chartres, 28630 Le Coudray, France
| | - Jean-Louis Georges
- Cardiology Department, Centre Hospitalier de Versailles, 78150 Le Chesnay-Rocquencourt, France
| | - Denis Angoulvant
- Cardiology Department, Centre Hospitalo-Universitaire de Tours, and Tours University, 37000 Tours, France
| | - Stephan Chassaing
- Cardiology Department, Centre Hospitalier Régional d'Orléans, 45100 Orléans, France
| | - Ronan Deballon
- Cardiology Department, Clinique Oréliance, 45770 Saran, France
| | - Pierre Marcollet
- Cardiology Department, Centre Hospitalier de Bourges, 18000 Bourges, France
| | - Franck Albert
- Cardiology Department, Les Hôpitaux de Chartres, 28630 Le Coudray, France
| | - Olivier Fichaux
- Cardiology Department, Centre Hospitalier Régional d'Orléans, 45100 Orléans, France
| | - Olivier Bar
- Cardiology Department, Nouvelle clinique Tourengelle, 37000 Tours, France
| | - Grégoire Rangé
- Cardiology Department, Les Hôpitaux de Chartres, 28630 Le Coudray, France
| |
Collapse
|
7
|
Levett JY, Windle SB, Filion KB, Cabaussel J, Eisenberg MJ. Meta-Analysis of Complete versus Culprit-Only Revascularization in Patients with ST-Segment Elevation Myocardial Infarction and Multivessel Coronary Disease. Am J Cardiol 2020; 135:40-49. [PMID: 32871112 DOI: 10.1016/j.amjcard.2020.08.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 08/09/2020] [Accepted: 08/11/2020] [Indexed: 12/15/2022]
Abstract
Approximately half of patients with ST-segment elevation myocardial infarction (STEMI) present with noninfarct related multivessel coronary artery disease (CAD) during primary percutaneous coronary intervention (PCI). However, questions remain concerning whether patients with STEMI and multivessel CAD should routinely undergo complete revascularization. Our objective was to compare the risks of major cardiovascular outcomes and procedural complications in patients with STEMI and multivessel CAD randomized to complete revascularization versus culprit-only PCI. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing complete revascularization to culprit-only PCI. RCTs were identified via a systematic search of MEDLINE, Embase, and Cochrane CENTRAL. Count data were pooled using DerSimonian and Laird random-effects models with inverse variance weighting to obtain relative risks (RRs) and 95% confidence intervals (CIs). A total of 9 RCTs (n = 6,751) were included, with mean/median follow-up times ranging from 6 to 36 months. Compared with culprit-only PCI, complete revascularization was associated with a substantial reduction in major adverse cardiovascular events (13.1% vs 22.1%; RR: 0.54; 95%CI: 0.43 to 0.66), repeat myocardial infarction (4.9% vs 6.8%; RR: 0.64; 95%CI: 0.48 to 0.84), and repeat revascularization (3.7% vs 12.3%; RR: 0.33; 95%CI: 0.25 to 0.44). Complete revascularization may have beneficial effects on all-cause and cardiovascular mortality, but 95%CIs were wide. Findings for stroke, major bleeding, and contrast-induced acute kidney injury were inconclusive. In conclusion, complete coronary artery revascularization appears to confer benefit over culprit-only PCI in patients with STEMI and multivessel CAD, and should be considered a first-line strategy in these patients.
Collapse
|
8
|
Patient Body Mass Index and Occupational Radiation Doses to Circulating Nurses During Coronary Angiography. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 26:48-52. [PMID: 33168435 DOI: 10.1016/j.carrev.2020.10.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/27/2020] [Accepted: 10/28/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Patient BMI is associated with radiation doses received by interventional cardiologists, yet the association between patient BMI and nurse radiation doses is unknown. This study evaluated the association between patient body mass index (BMI) and nurse radiation doses during coronary angiography. METHODS Nurse radiation doses were collected by real-time dosimeters during consecutive coronary angiography procedures and are reported as the personal dose equivalent (Hp10). Patient radiation doses were estimated using dose area product (DAP). Patient BMI was categorized in kg/m2 as <25.0, 25.0-29.9, 30.0-34.9, 35.0-39.9, and ≥40. Multiple regression analysis determined procedural factors independently association with nurse radiation doses. RESULTS In 643 consecutive coronary angiography procedures, patient radiation doses increased significantly across increasing patient BMI categories (p < 0.001). Compared to a patient BMI <25, a patient BMI ≥40 was associated with a 2.3-fold increase in DAP (p < 0.001). Significant differences were also observed in nurse radiation doses across patient BMI categories (p = 0.036). Compared to a patient BMI <25, a patient BMI ≥40 was associated with a 4.0-fold increase in nurse radiation dose (BMI < 25: 0.3 [0.1, 1.3] μSv; BMI ≥ 40: 1.2 [0.2, 2.9] μSv; p = 0.003). By multiple regression analysis, each 1-unit kg/m2 increase in patient BMI was associated with a 3.3% increase in nurse radiation dose (p = 0.002). CONCLUSIONS Patient BMI was significantly associated with nurse radiation doses during coronary angiography. These observations may have important implications on nurse radiation safety, especially in the setting of the ongoing obesity epidemic.
Collapse
|
9
|
Podgorsak AR, Sommer KN, Reddy A, Iyer V, Wilson MF, Rybicki FJ, Mitsouras D, Sharma U, Fujimoto S, Kumamaru KK, Angel E, Ionita CN. Initial evaluation of a convolutional neural network used for noninvasive assessment of coronary artery disease severity from coronary computed tomography angiography data. Med Phys 2020; 47:3996-4004. [DOI: 10.1002/mp.14339] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/09/2020] [Accepted: 06/10/2020] [Indexed: 12/13/2022] Open
Affiliation(s)
- Alexander R. Podgorsak
- From the Canon Stroke and Vascular Research Center 875 Ellicott Street Buffalo NY 14222USA
| | - Kelsey N. Sommer
- From the Canon Stroke and Vascular Research Center 875 Ellicott Street Buffalo NY 14222USA
| | - Abhinay Reddy
- From the Canon Stroke and Vascular Research Center 875 Ellicott Street Buffalo NY 14222USA
| | - Vijay Iyer
- From the Canon Stroke and Vascular Research Center 875 Ellicott Street Buffalo NY 14222USA
| | - Michael F. Wilson
- From the Canon Stroke and Vascular Research Center 875 Ellicott Street Buffalo NY 14222USA
| | - Frank J. Rybicki
- Department of Radiology University of Cincinnati 234 Goodman Street Cincinnati OH USA
| | - Dimitrios Mitsouras
- San Francisco Department of Radiology and Biomedical Imaging University of California 505 Parnassus Avenue San Francisco CA 94143USA
| | - Umesh Sharma
- From the Canon Stroke and Vascular Research Center 875 Ellicott Street Buffalo NY 14222USA
| | - Shinchiro Fujimoto
- Department of Cardiovascular Medicine Juntendo University 3‐1‐3 Hongo, Bunkyo‐ku Tokyo Japan
| | - Kanako K. Kumamaru
- Department of Radiology Juntendo University 3‐1‐3 Hongo, Bunkyo‐ku Tokyo Japan
| | - Erin Angel
- Canon Medical Systems USA, Inc. 2441 Michelle Drive Tustin CA 92780USA
| | - Ciprian N. Ionita
- From the Canon Stroke and Vascular Research Center 875 Ellicott Street Buffalo NY 14222USA
| |
Collapse
|
10
|
Non-hyperaemic coronary pressure measurements to guide coronary interventions. Nat Rev Cardiol 2020; 17:629-640. [DOI: 10.1038/s41569-020-0374-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/31/2020] [Indexed: 01/11/2023]
|
11
|
Mangiacapra F, Bressi E, Di Gioia G, Pellicano M, Di Serafino L, Peace AJ, Bartunek J, Morisco C, Wijns W, De Bruyne B, Barbato E. Coronary microcirculation and peri-procedural myocardial injury during elective percutaneous coronary intervention. Int J Cardiol 2020; 306:42-46. [DOI: 10.1016/j.ijcard.2019.12.042] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 12/02/2019] [Accepted: 12/23/2019] [Indexed: 10/25/2022]
|
12
|
De la Garza-Salazar F, Lankenau-Vela DL, Cadena-Nuñez B, González-Cantú A, Romero-Ibarguengoitia ME. The Effect of Functional and Intra-Coronary Imaging Techniques on Fluoroscopy Time, Radiation Dose and Contrast Volume during Coronary Angiography. Sci Rep 2020; 10:6950. [PMID: 32332840 PMCID: PMC7181823 DOI: 10.1038/s41598-020-63791-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 04/05/2020] [Indexed: 12/02/2022] Open
Abstract
The aim was to analyze the effect of fractional flow reserve (FFR), intravascular ultrasound (IVUS) and optical coherence tomography (OCT) on fluoroscopy time (FT), radiation dose (RD) and contrast volume (CV) in patients undergoing coronary angiography. This case-control study included consecutive patients above the age of 18, who underwent coronary angiography. FT, RD, and CV after each procedure were retrospectively recorded. Multivariate models were used to demonstrate the effect of these complementary studies and other factors, on radiation and contrast exposure. A total of 1047 patients were included, 74.5% were men and the mean (SD) age was 62.4 (12.1) years. Complementary studies performed were: IVUS (n = 237), FFR (n = 56) and OCT (n = 37). FFR and IVUS had a small effect on FT (η = 0.008 B = 2.2, p < 0.001; η = 0.009, B = 2.5, p < 0.001), while OCT had no effect (η = 0.002 B = 2.9, p < 0.183). IVUS, FFR and OCT had no effect on the RD. IVUS did not affect contrast volume (η = 0.002 B = 9.4, p < 0.163) while OCT and FFR had a small effect on CV (η = 0.006 B = 39, p < 0.01; η = 0.008 B = 37, p < 0.003). The number of placed stents had a significant effect on FT (η = 0.192, Β = 4.2, p < 0.001), RD (η = 0.129, Β = 511.8, p < 0.001) and CV (η = 0.177, Β = 40.5, p < 0.001). The use of complementary studies in hemodynamics did not modify the received RD and had a minor effect on FT and the CV used.
Collapse
Affiliation(s)
- Fernando De la Garza-Salazar
- Universidad de Monterrey, Facultad de Medicina, Especialidades Médicas. Av. Ignacio Morones Prieto 4500, Jesús M. Garza, 66238, San Pedro Garza García, Nuevo Leon, Mexico.,Hospital Christus Muguerza Alta Especialidad: Miguel Hidalgo, 2525, Obispado, 64060 Monterrey, Nuevo Leon, Mexico
| | - Diana Lorena Lankenau-Vela
- Universidad de Monterrey, Facultad de Medicina, Especialidades Médicas. Av. Ignacio Morones Prieto 4500, Jesús M. Garza, 66238, San Pedro Garza García, Nuevo Leon, Mexico.,Hospital Christus Muguerza Alta Especialidad: Miguel Hidalgo, 2525, Obispado, 64060 Monterrey, Nuevo Leon, Mexico
| | - Bertha Cadena-Nuñez
- Hospital Ángeles Tampico: Av. Miguel Hidalgo 5503, Choferes, 89330, Tampico, Tamaulipas, Mexico
| | - Arnulfo González-Cantú
- Universidad de Monterrey, Facultad de Medicina, Especialidades Médicas. Av. Ignacio Morones Prieto 4500, Jesús M. Garza, 66238, San Pedro Garza García, Nuevo Leon, Mexico.,Hospital Christus Muguerza Alta Especialidad: Miguel Hidalgo, 2525, Obispado, 64060 Monterrey, Nuevo Leon, Mexico
| | - Maria Elena Romero-Ibarguengoitia
- Universidad de Monterrey, Facultad de Medicina, Especialidades Médicas. Av. Ignacio Morones Prieto 4500, Jesús M. Garza, 66238, San Pedro Garza García, Nuevo Leon, Mexico. .,Hospital Christus Muguerza Alta Especialidad: Miguel Hidalgo, 2525, Obispado, 64060 Monterrey, Nuevo Leon, Mexico.
| |
Collapse
|
13
|
Omori H, Witberg G, Kawase Y, Tanigaki T, Okamoto S, Hirata T, Sobue Y, Ota H, Kamiya H, Okubo M, Valzer O, Kornowski R, Matsuo H. Angiogram based fractional flow reserve in patients with dual/triple vessel coronary artery disease. Int J Cardiol 2019; 283:17-22. [PMID: 30819589 DOI: 10.1016/j.ijcard.2019.01.072] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 12/06/2018] [Accepted: 01/21/2019] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To assess the performance of angiography derived Fractional Flow Reserve (FFRangio) in multivessel disease (MVD) patients undergoing angiography. BACKGROUND FFR is the reference standard for physiologic assessment of coronary stenosis and guidance of revascularization, especially in patients with MVD, yet it remains grossly underutilized. The non-wire based FFRangio performs well in non-MVD patients, but its accuracy in MVD is unknown. METHODS A prospective clinical study was conducted at Gifu Heart Centre, Japan. Patients underwent physiologic assessment of all relevant coronary lesions using wire-based FFR (wbFFR) and FFRangio. Primary outcome was diagnostic performance (sensitivity, specificity, accuracy) for FFRangio with wbFFR as reference. Other outcomes were the correlation between wbFFR/FFRangio, time required for wbFFR/FFRangio measurements, and the effect of wbFFR/FFRangio on the reclassification of coronary disease severity. RESULTS Fifty patients (118 lesions in total) were included. Mean age was 72 ± 9 years, 72% were male, 36% had triple vessel disease and the average SYNTAX score was 13. The mean measurement of wbFFR and FFRangio were 0.83 ± 0.12 and 0.81 ± 0.11, respectively. Accuracy, sensitivity and specificity for FFRangio were 92.3% (95% CI 79.1-98.4%), 92.4% (95% CI 84.3-97.2%) and 92.4% (95% CI 87.4-97.3%), respectively. Pearson's r between wbFFR and FFRangio was 0.83. FFRangio measurement was faster than wbFFR (9.6 ± 3.4 vs. 15.0 ± 8.9 min, p < 0.001). CONCLUSIONS In patients with MVD, FFRangio shows good correlation and excellent diagnostic performance compared to wbFFR, and measuring FFRangio is faster than wbFFR. These results highlight the potential clinical benefits of utilizing FFRangio among patients with MVD.
Collapse
Affiliation(s)
- H Omori
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan
| | - G Witberg
- Department of Cardiology, Rabin Medical Center, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Y Kawase
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan
| | - T Tanigaki
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan
| | - S Okamoto
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan
| | - T Hirata
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan
| | - Y Sobue
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan
| | - H Ota
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan
| | - H Kamiya
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan
| | - M Okubo
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan
| | - O Valzer
- Department of Cardiology, Rabin Medical Center, Petah-Tikva, Israel; CathWorks, Kfar-Saba, Israel
| | - R Kornowski
- Department of Cardiology, Rabin Medical Center, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - H Matsuo
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan
| |
Collapse
|
14
|
Djordjevic Dikic A, Tesic M, Boskovic N, Giga V, Stepanovic J, Petrovic M, Dobric M, Aleksandric S, Juricic S, Dikic M, Nedeljkovic I, Nedeljkovic M, Ostojic M, Beleslin B. Prognostic Value of Preserved Coronary Flow Velocity Reserve by Noninvasive Transthoracic Doppler Echocardiography in Patients With Angiographically Intermediate Left Main Stenosis. J Am Soc Echocardiogr 2018; 32:74-80. [PMID: 30459120 DOI: 10.1016/j.echo.2018.09.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND The potential of angiography to evaluate the hemodynamic severity of a left main coronary artery (LM) stenosis is limited. Noninvasive transthoracic Doppler echocardiographic coronary flow velocity reserve (CFVR) evaluation of intermediate coronary stenosis has demonstrated remarkably high negative prognostic value. The aim of this study was to assess clinical outcomes in patients with angiographically intermediate LM stenosis and preserved CFVR (>2.0) as evaluated by transthoracic Doppler echocardiographic CFVR. METHODS The initial study population included 102 patients with intermediate coronary stenosis of the LM referred for transthoracic Doppler echocardiographic CFVR assessment. Peak diastolic CFVR measurements were performed in the distal segment of the left anterior descending coronary artery after intravenous adenosine (140 μg/kg/min), and CFVR was calculated as the ratio between maximal hyperemic and baseline coronary flow velocity. Nineteen patients had impaired CFVR (≤2.0) and were excluded from further analysis, as well as two patients with poor acoustic windows. The final group consisted of 81 patients (mean age, 60 ± 9 years; 76 men) evaluated for adverse cardiac events including death, myocardial infarction, and revascularization. RESULTS Mean follow-up duration was 62 ± 26 months. Mean CFVR was 2.4 ± 0.4. Total event-free survival was 75 of 81 (92.6%), as six patients were referred for revascularization (five patients with coronary artery bypass grafting, one patient with percutaneous coronary intervention). There were no documented myocardial infarctions or cardiovascular deaths in the follow-up period. CONCLUSIONS In patients with angiographically intermediate and equivocal LM stenosis and preserved CFVR values of >2.0, revascularization can be safely deferred.
Collapse
Affiliation(s)
- Ana Djordjevic Dikic
- Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia; Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Milorad Tesic
- Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia; Medical Faculty, University of Belgrade, Belgrade, Serbia
| | | | - Vojislav Giga
- Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia; Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Jelena Stepanovic
- Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia; Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Marija Petrovic
- Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia
| | - Milan Dobric
- Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia; Medical Faculty, University of Belgrade, Belgrade, Serbia
| | | | - Stefan Juricic
- Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia
| | - Miodrag Dikic
- Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia
| | - Ivana Nedeljkovic
- Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia; Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Milan Nedeljkovic
- Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia; Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Miodrag Ostojic
- Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia; Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Branko Beleslin
- Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia; Medical Faculty, University of Belgrade, Belgrade, Serbia.
| |
Collapse
|
15
|
Mangiacapra F, Bressi E, Sticchi A, Morisco C, Barbato E. Fractional flow reserve (FFR) as a guide to treat coronary artery disease. Expert Rev Cardiovasc Ther 2018; 16:465-477. [PMID: 29923434 DOI: 10.1080/14779072.2018.1489236] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
INTRODUCTION The presence and extent of myocardial ischemia are the major determinants of prognosis in patients with coronary artery disease (CAD). Unlike coronary angiography alone, fractional flow reserve (FFR) has enabled interventional cardiologists to accurately determine whether coronary atherosclerotic plaques are responsible for myocardial ischemia, and therefore deserve to be revascularized. Areas covered: An overview on the role of FFR in the diagnosis and treatment of coronary artery disease, as well as the potential related controversies is provided. Authors describe the coronary physiology underneath this technique and all the procedural aspects in the catheterization laboratory. The landmark trials and the current applications in different coronary lesions and syndromes are also described and potential future research involving FFR and comparisons with other methodologies for the evaluation of coronary physiology are introduced. Expert commentary: FFR is still unsurpassed in diagnostic performance when compared to non-hyperemic indices and noninvasive techniques, and remains the gold standard for the detection of ischemia-inducing coronary stenoses. FFR-guided PCI has been demonstrated superior to an angiography-guided PCI and over medical therapy alone, and ongoing investigation will clarify whether it could perform better, or at least equalize the results of cardiac surgery in patients with severe multivessel disease.
Collapse
Affiliation(s)
- Fabio Mangiacapra
- a Unit of Cardiovascular Science , Campus Bio-Medico University , Rome , Italy
| | - Edoardo Bressi
- a Unit of Cardiovascular Science , Campus Bio-Medico University , Rome , Italy
| | - Alessandro Sticchi
- a Unit of Cardiovascular Science , Campus Bio-Medico University , Rome , Italy
| | - Carmine Morisco
- b Department of Advanced Biomedical Sciences , University of Naples Federico II , Napoli , Italy
| | - Emanuele Barbato
- b Department of Advanced Biomedical Sciences , University of Naples Federico II , Napoli , Italy.,c Cardiovascular Research Center Aalst , OLV Hospital , Aalst , Belgium
| |
Collapse
|
16
|
Pothineni NVK, Edupuganti MM, Almomani A, Payne J, Raina S, Fnu S, Abualsuod A, Wong J, Uretsky BF, Hakeem A. Comparison of the prognostic value of non-ischaemic fractional flow reserve using intracoronary versus intravenous adenosine. EUROINTERVENTION 2018; 13:1680-1687. [DOI: 10.4244/eij-d-16-00375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
|
17
|
Boccalandro F, Dhindsa M, Subramaniyam P, Mok M. Feasibility of coronary fractional flow reserve with dual anti-platelet therapy in low risk coronary lesions without systemic anticoagulation-results of the SMART-FFR study. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2017; 19:343-347. [PMID: 28927636 DOI: 10.1016/j.carrev.2017.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Revised: 08/13/2017] [Accepted: 08/15/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND Fractional flow reserve (FFR) is used to assess the functional significance of coronary artery stenoses. The optimal anti-thrombotic regimen for FFR has not been studied. PURPOSE The goal of this study was to determine whether FFR could be safely performed in Type A coronary lesions, using only upstream dual anti-platelet therapy (DAT) with aspirin and clopidogrel, compared with DAT plus anticoagulation in low risk coronary lesions. METHODS/MATERIALS Two hundred patients undergoing FFR for Type A intermediate coronary lesions were blindly randomized into two groups of 100 patients each. Group 1: Upstream DAT, without intra-procedural anti-coagulation and Group 2: Upstream DAT plus intra-procedural bivalirudin. The primary end-points were any coronary thrombotic complications during the index hospital stay, and a composite end-point of any major adverse cardiovascular events (MACE) at 30-days. Secondary end-points included post-procedure troponin levels and TIMI major and minor bleeding scores. RESULTS There were no thrombotic complications reported. At 30-days, two MACE occurred in Group 1, and three in Group 2 (p=0.83). No difference was seen in the post-procedure troponin levels (p=0.72), or TIMI bleeding scores study between groups (p=093). CONCLUSIONS This initial study evaluating a simplified anti-thrombotic regimen for FFR, suggests that FFR can be performed in low risk coronary lesions using DAT without the need for intra-procedural anticoagulation, with similar results as DAT plus anticoagulation with bivalirudin. Further research in this area is needed to determine the optimal and most cost-effective anti-thrombotic regimen for FFR calculation.
Collapse
Affiliation(s)
- Fernando Boccalandro
- ProCare - Odessa Heart Institute, Odessa, TX, United States; Permian Research Foundation, Odessa, TX, United States; Department of Internal Medicine, Texas Tech University Health Science Center, Odessa, TX, United States.
| | - Mandeep Dhindsa
- Department of Internal Medicine, Texas Tech University Health Science Center, Odessa, TX, United States
| | - Prem Subramaniyam
- Michigan State University, Department of Internal Medicine, Lansing, MI, United States
| | - Mary Mok
- University of Texas San Antonio, Department of Internal Medicine, San Antonio, TX, United States
| |
Collapse
|
18
|
Pellicano M, Lavi I, De Bruyne B, Vaknin-Assa H, Assali A, Valtzer O, Lotringer Y, Weisz G, Almagor Y, Xaplanteris P, Kirtane AJ, Codner P, Leon MB, Kornowski R. Validation Study of Image-Based Fractional Flow Reserve During Coronary Angiography. Circ Cardiovasc Interv 2017; 10:CIRCINTERVENTIONS.116.005259. [DOI: 10.1161/circinterventions.116.005259] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 07/17/2017] [Indexed: 11/16/2022]
Abstract
Background—
Fractional flow reserve (FFR), an index of the hemodynamic severity of coronary stenoses, is derived from invasive measurements and requires a pressure-monitoring guidewire and hyperemic stimulus. Angiography-derived FFR measurements (FFR
angio
) may have several advantages. The aim of this study is to assess the diagnostic performance and interobserver reproducibility of FFR
angio
in patients with stable coronary artery disease.
Methods and Results—
FFR
angio
is a computational method based on rapid flow analysis for the assessment of FFR. FFR
angio
uses the patient’s hemodynamic data and routine angiograms to generate a complete 3-dimensional coronary tree with color-coded FFR values at any epicardial location. Hyperemic flow ratio is derived from an automatic resistance-based lumped model of the entire coronary tree. A total of 203 lesions were analyzed in 184 patients from 4 centers. Values derived using FFR
angio
ranged from 0.5 to 0.97 (median 0.85) and correlated closely (Spearman ρ=0.90;
P
<0.001) with the invasive FFR measurements, which ranged from 0.5 to 1 (median 0.84). In Bland–Altman analyses, the 95% limits of agreement between these methods ranged from −0.096 to 0.112. Using an FFR cutoff value of 0.80, the sensitivity, specificity, and diagnostic accuracy of FFR
angio
were 88%, 95%, and 93%, respectively. The intraclass coefficient between 2 blinded operators was 0.962 with a 95% confidence interval from 0.950 to 0.971,
P
<0.001.
Conclusions—
There is a high concordance between FFR
angio
and invasive FFR. The color-coded display of FFR values during coronary angiography facilitates the integration of physiology and anatomy for decision making on revascularization in patients with stable coronary artery disease.
Clinical Trial Registration—
URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT03005028.
Collapse
Affiliation(s)
- Mariano Pellicano
- From the Cardiovascular Center Aalst, OLV Hospital, Belgium (M.P., B.D.B., P.X.); Rabin Medical Center, Petach Tikva, Israel (I.L., H.V.-A., A.A., O.V., P.C., R.K.); Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy (M.P.); CathWorks Ltd, Ra’anana, Israel (I.L., O.V., Y.L.); Columbia University Medical Center, New York-Presbyterian Hospital (A.J.K., P.C., M.B.L.); and Shaare Zedek Medical Center, Jerusalem, Israel (G.W., Y.A.)
| | - Ifat Lavi
- From the Cardiovascular Center Aalst, OLV Hospital, Belgium (M.P., B.D.B., P.X.); Rabin Medical Center, Petach Tikva, Israel (I.L., H.V.-A., A.A., O.V., P.C., R.K.); Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy (M.P.); CathWorks Ltd, Ra’anana, Israel (I.L., O.V., Y.L.); Columbia University Medical Center, New York-Presbyterian Hospital (A.J.K., P.C., M.B.L.); and Shaare Zedek Medical Center, Jerusalem, Israel (G.W., Y.A.)
| | - Bernard De Bruyne
- From the Cardiovascular Center Aalst, OLV Hospital, Belgium (M.P., B.D.B., P.X.); Rabin Medical Center, Petach Tikva, Israel (I.L., H.V.-A., A.A., O.V., P.C., R.K.); Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy (M.P.); CathWorks Ltd, Ra’anana, Israel (I.L., O.V., Y.L.); Columbia University Medical Center, New York-Presbyterian Hospital (A.J.K., P.C., M.B.L.); and Shaare Zedek Medical Center, Jerusalem, Israel (G.W., Y.A.)
| | - Hana Vaknin-Assa
- From the Cardiovascular Center Aalst, OLV Hospital, Belgium (M.P., B.D.B., P.X.); Rabin Medical Center, Petach Tikva, Israel (I.L., H.V.-A., A.A., O.V., P.C., R.K.); Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy (M.P.); CathWorks Ltd, Ra’anana, Israel (I.L., O.V., Y.L.); Columbia University Medical Center, New York-Presbyterian Hospital (A.J.K., P.C., M.B.L.); and Shaare Zedek Medical Center, Jerusalem, Israel (G.W., Y.A.)
| | - Abid Assali
- From the Cardiovascular Center Aalst, OLV Hospital, Belgium (M.P., B.D.B., P.X.); Rabin Medical Center, Petach Tikva, Israel (I.L., H.V.-A., A.A., O.V., P.C., R.K.); Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy (M.P.); CathWorks Ltd, Ra’anana, Israel (I.L., O.V., Y.L.); Columbia University Medical Center, New York-Presbyterian Hospital (A.J.K., P.C., M.B.L.); and Shaare Zedek Medical Center, Jerusalem, Israel (G.W., Y.A.)
| | - Orna Valtzer
- From the Cardiovascular Center Aalst, OLV Hospital, Belgium (M.P., B.D.B., P.X.); Rabin Medical Center, Petach Tikva, Israel (I.L., H.V.-A., A.A., O.V., P.C., R.K.); Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy (M.P.); CathWorks Ltd, Ra’anana, Israel (I.L., O.V., Y.L.); Columbia University Medical Center, New York-Presbyterian Hospital (A.J.K., P.C., M.B.L.); and Shaare Zedek Medical Center, Jerusalem, Israel (G.W., Y.A.)
| | - Yonit Lotringer
- From the Cardiovascular Center Aalst, OLV Hospital, Belgium (M.P., B.D.B., P.X.); Rabin Medical Center, Petach Tikva, Israel (I.L., H.V.-A., A.A., O.V., P.C., R.K.); Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy (M.P.); CathWorks Ltd, Ra’anana, Israel (I.L., O.V., Y.L.); Columbia University Medical Center, New York-Presbyterian Hospital (A.J.K., P.C., M.B.L.); and Shaare Zedek Medical Center, Jerusalem, Israel (G.W., Y.A.)
| | - Giora Weisz
- From the Cardiovascular Center Aalst, OLV Hospital, Belgium (M.P., B.D.B., P.X.); Rabin Medical Center, Petach Tikva, Israel (I.L., H.V.-A., A.A., O.V., P.C., R.K.); Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy (M.P.); CathWorks Ltd, Ra’anana, Israel (I.L., O.V., Y.L.); Columbia University Medical Center, New York-Presbyterian Hospital (A.J.K., P.C., M.B.L.); and Shaare Zedek Medical Center, Jerusalem, Israel (G.W., Y.A.)
| | - Yaron Almagor
- From the Cardiovascular Center Aalst, OLV Hospital, Belgium (M.P., B.D.B., P.X.); Rabin Medical Center, Petach Tikva, Israel (I.L., H.V.-A., A.A., O.V., P.C., R.K.); Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy (M.P.); CathWorks Ltd, Ra’anana, Israel (I.L., O.V., Y.L.); Columbia University Medical Center, New York-Presbyterian Hospital (A.J.K., P.C., M.B.L.); and Shaare Zedek Medical Center, Jerusalem, Israel (G.W., Y.A.)
| | - Panagiotis Xaplanteris
- From the Cardiovascular Center Aalst, OLV Hospital, Belgium (M.P., B.D.B., P.X.); Rabin Medical Center, Petach Tikva, Israel (I.L., H.V.-A., A.A., O.V., P.C., R.K.); Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy (M.P.); CathWorks Ltd, Ra’anana, Israel (I.L., O.V., Y.L.); Columbia University Medical Center, New York-Presbyterian Hospital (A.J.K., P.C., M.B.L.); and Shaare Zedek Medical Center, Jerusalem, Israel (G.W., Y.A.)
| | - Ajay J. Kirtane
- From the Cardiovascular Center Aalst, OLV Hospital, Belgium (M.P., B.D.B., P.X.); Rabin Medical Center, Petach Tikva, Israel (I.L., H.V.-A., A.A., O.V., P.C., R.K.); Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy (M.P.); CathWorks Ltd, Ra’anana, Israel (I.L., O.V., Y.L.); Columbia University Medical Center, New York-Presbyterian Hospital (A.J.K., P.C., M.B.L.); and Shaare Zedek Medical Center, Jerusalem, Israel (G.W., Y.A.)
| | - Pablo Codner
- From the Cardiovascular Center Aalst, OLV Hospital, Belgium (M.P., B.D.B., P.X.); Rabin Medical Center, Petach Tikva, Israel (I.L., H.V.-A., A.A., O.V., P.C., R.K.); Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy (M.P.); CathWorks Ltd, Ra’anana, Israel (I.L., O.V., Y.L.); Columbia University Medical Center, New York-Presbyterian Hospital (A.J.K., P.C., M.B.L.); and Shaare Zedek Medical Center, Jerusalem, Israel (G.W., Y.A.)
| | - Martin B. Leon
- From the Cardiovascular Center Aalst, OLV Hospital, Belgium (M.P., B.D.B., P.X.); Rabin Medical Center, Petach Tikva, Israel (I.L., H.V.-A., A.A., O.V., P.C., R.K.); Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy (M.P.); CathWorks Ltd, Ra’anana, Israel (I.L., O.V., Y.L.); Columbia University Medical Center, New York-Presbyterian Hospital (A.J.K., P.C., M.B.L.); and Shaare Zedek Medical Center, Jerusalem, Israel (G.W., Y.A.)
| | - Ran Kornowski
- From the Cardiovascular Center Aalst, OLV Hospital, Belgium (M.P., B.D.B., P.X.); Rabin Medical Center, Petach Tikva, Israel (I.L., H.V.-A., A.A., O.V., P.C., R.K.); Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy (M.P.); CathWorks Ltd, Ra’anana, Israel (I.L., O.V., Y.L.); Columbia University Medical Center, New York-Presbyterian Hospital (A.J.K., P.C., M.B.L.); and Shaare Zedek Medical Center, Jerusalem, Israel (G.W., Y.A.)
| |
Collapse
|
19
|
Case Report of First Angiography-Based On-Line FFR Assessment during Coronary Catheterization. Case Rep Cardiol 2017; 2017:6107327. [PMID: 28835858 PMCID: PMC5556601 DOI: 10.1155/2017/6107327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 06/19/2017] [Accepted: 07/03/2017] [Indexed: 11/17/2022] Open
Abstract
Fractional flow reserve (FFR), an index of the hemodynamic severity of coronary stenoses, is derived from hyperemic pressure measurements and requires a pressure-monitoring guide wire and hyperemic stimulus. Although it has become the standard of reference for decision-making regarding coronary revascularization, the procedure remains underutilized due to its invasive nature. FFRangio is a novel technology that uses the patient's hemodynamic data and routine angiograms to generate a complete three-dimensional coronary tree, with color-coded display of the FFR values at each point along the vessels. After being proven to be as accurate as invasive FFR measurements in an off-line study, this case report presents the first on-line application of the system in the catheterization lab. Here too, a high concordance between FFRangio and invasive FFR was observed. In light of the demonstrated capabilities of the FFRangio system, it should emerge as an important tool for clinical decision-making regarding revascularization in patients with coronary artery disease.
Collapse
|
20
|
Layland J, Rauhalammi S, Watkins S, Ahmed N, McClure J, Lee MM, Carrick D, O’Donnell A, Sood A, Petrie MC, Teng Yue May V, Eteiba H, Lindsay M, McEntegart M, Oldroyd KG, Radjenovic A, Berry C. Assessment of Fractional Flow Reserve in Patients With Recent Non–ST-Segment–Elevation Myocardial Infarction. Circ Cardiovasc Interv 2015; 8:e002207. [PMID: 26253733 DOI: 10.1161/circinterventions.114.002207] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Jamie Layland
- From the West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom (J.L., S.W., N.A., M.M.Y.L., D.C., A.O., M.C.P., H.E., M.L., M.M., K.G.O., C.B.); BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (J.L., S.R., N.A., J.M., D.C., V.T.Y.M., A.R., C.B.); and Hairmyres Hospital, Hairmyres, East Kilbride, United Kingdom (A.S.)
| | - Samuli Rauhalammi
- From the West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom (J.L., S.W., N.A., M.M.Y.L., D.C., A.O., M.C.P., H.E., M.L., M.M., K.G.O., C.B.); BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (J.L., S.R., N.A., J.M., D.C., V.T.Y.M., A.R., C.B.); and Hairmyres Hospital, Hairmyres, East Kilbride, United Kingdom (A.S.)
| | - Stuart Watkins
- From the West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom (J.L., S.W., N.A., M.M.Y.L., D.C., A.O., M.C.P., H.E., M.L., M.M., K.G.O., C.B.); BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (J.L., S.R., N.A., J.M., D.C., V.T.Y.M., A.R., C.B.); and Hairmyres Hospital, Hairmyres, East Kilbride, United Kingdom (A.S.)
| | - Nadeem Ahmed
- From the West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom (J.L., S.W., N.A., M.M.Y.L., D.C., A.O., M.C.P., H.E., M.L., M.M., K.G.O., C.B.); BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (J.L., S.R., N.A., J.M., D.C., V.T.Y.M., A.R., C.B.); and Hairmyres Hospital, Hairmyres, East Kilbride, United Kingdom (A.S.)
| | - John McClure
- From the West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom (J.L., S.W., N.A., M.M.Y.L., D.C., A.O., M.C.P., H.E., M.L., M.M., K.G.O., C.B.); BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (J.L., S.R., N.A., J.M., D.C., V.T.Y.M., A.R., C.B.); and Hairmyres Hospital, Hairmyres, East Kilbride, United Kingdom (A.S.)
| | - Matthew M.Y. Lee
- From the West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom (J.L., S.W., N.A., M.M.Y.L., D.C., A.O., M.C.P., H.E., M.L., M.M., K.G.O., C.B.); BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (J.L., S.R., N.A., J.M., D.C., V.T.Y.M., A.R., C.B.); and Hairmyres Hospital, Hairmyres, East Kilbride, United Kingdom (A.S.)
| | - David Carrick
- From the West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom (J.L., S.W., N.A., M.M.Y.L., D.C., A.O., M.C.P., H.E., M.L., M.M., K.G.O., C.B.); BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (J.L., S.R., N.A., J.M., D.C., V.T.Y.M., A.R., C.B.); and Hairmyres Hospital, Hairmyres, East Kilbride, United Kingdom (A.S.)
| | - Anna O’Donnell
- From the West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom (J.L., S.W., N.A., M.M.Y.L., D.C., A.O., M.C.P., H.E., M.L., M.M., K.G.O., C.B.); BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (J.L., S.R., N.A., J.M., D.C., V.T.Y.M., A.R., C.B.); and Hairmyres Hospital, Hairmyres, East Kilbride, United Kingdom (A.S.)
| | - Arvind Sood
- From the West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom (J.L., S.W., N.A., M.M.Y.L., D.C., A.O., M.C.P., H.E., M.L., M.M., K.G.O., C.B.); BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (J.L., S.R., N.A., J.M., D.C., V.T.Y.M., A.R., C.B.); and Hairmyres Hospital, Hairmyres, East Kilbride, United Kingdom (A.S.)
| | - Mark C. Petrie
- From the West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom (J.L., S.W., N.A., M.M.Y.L., D.C., A.O., M.C.P., H.E., M.L., M.M., K.G.O., C.B.); BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (J.L., S.R., N.A., J.M., D.C., V.T.Y.M., A.R., C.B.); and Hairmyres Hospital, Hairmyres, East Kilbride, United Kingdom (A.S.)
| | - Vannesa Teng Yue May
- From the West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom (J.L., S.W., N.A., M.M.Y.L., D.C., A.O., M.C.P., H.E., M.L., M.M., K.G.O., C.B.); BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (J.L., S.R., N.A., J.M., D.C., V.T.Y.M., A.R., C.B.); and Hairmyres Hospital, Hairmyres, East Kilbride, United Kingdom (A.S.)
| | - Hany Eteiba
- From the West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom (J.L., S.W., N.A., M.M.Y.L., D.C., A.O., M.C.P., H.E., M.L., M.M., K.G.O., C.B.); BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (J.L., S.R., N.A., J.M., D.C., V.T.Y.M., A.R., C.B.); and Hairmyres Hospital, Hairmyres, East Kilbride, United Kingdom (A.S.)
| | - Mitchell Lindsay
- From the West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom (J.L., S.W., N.A., M.M.Y.L., D.C., A.O., M.C.P., H.E., M.L., M.M., K.G.O., C.B.); BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (J.L., S.R., N.A., J.M., D.C., V.T.Y.M., A.R., C.B.); and Hairmyres Hospital, Hairmyres, East Kilbride, United Kingdom (A.S.)
| | - Margaret McEntegart
- From the West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom (J.L., S.W., N.A., M.M.Y.L., D.C., A.O., M.C.P., H.E., M.L., M.M., K.G.O., C.B.); BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (J.L., S.R., N.A., J.M., D.C., V.T.Y.M., A.R., C.B.); and Hairmyres Hospital, Hairmyres, East Kilbride, United Kingdom (A.S.)
| | - Keith G. Oldroyd
- From the West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom (J.L., S.W., N.A., M.M.Y.L., D.C., A.O., M.C.P., H.E., M.L., M.M., K.G.O., C.B.); BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (J.L., S.R., N.A., J.M., D.C., V.T.Y.M., A.R., C.B.); and Hairmyres Hospital, Hairmyres, East Kilbride, United Kingdom (A.S.)
| | - Aleksandra Radjenovic
- From the West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom (J.L., S.W., N.A., M.M.Y.L., D.C., A.O., M.C.P., H.E., M.L., M.M., K.G.O., C.B.); BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (J.L., S.R., N.A., J.M., D.C., V.T.Y.M., A.R., C.B.); and Hairmyres Hospital, Hairmyres, East Kilbride, United Kingdom (A.S.)
| | - Colin Berry
- From the West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom (J.L., S.W., N.A., M.M.Y.L., D.C., A.O., M.C.P., H.E., M.L., M.M., K.G.O., C.B.); BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (J.L., S.R., N.A., J.M., D.C., V.T.Y.M., A.R., C.B.); and Hairmyres Hospital, Hairmyres, East Kilbride, United Kingdom (A.S.)
| |
Collapse
|
21
|
Pooled comparison of regadenoson versus adenosine for measuring fractional flow reserve and coronary flow in the catheterization laboratory. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2015; 16:266-71. [PMID: 26242981 DOI: 10.1016/j.carrev.2015.05.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 05/13/2015] [Accepted: 05/28/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND Adenosine is the gold standard for augmenting coronary flow during fractional flow reserve (FFR) testing of intermediate coronary stenoses. However, intravenous infusion is time-consuming and intracoronary injection is subject to variability. Regadenoson is a newer adenosine alternative administered as a single intravenous bolus during nuclear stress testing, but its efficacy and safety during FFR testing have been evaluated only in small, single-center studies. METHODS We pooled data from 5 academic hospitals, in which patients undergoing clinically-indicated FFR prospectively underwent comparison of intravenous adenosine infusion (140-175mcg/kg/min) versus regadenoson bolus (400mcg). Hemodynamics and symptoms with adenosine were recorded until maximal hyperemia occurred, and after returning to baseline hemodynamics, regadenoson was administered and monitoring was repeated. In a subset of patients with coronary flow data, average peak velocity (APV) at the distal flow sensor was recorded. RESULTS Of 149 patients enrolled, mean age was 59±9years, 76% were male, and 54% underwent testing of the left anterior descending artery. Mean adenosine-FFR and regadenoson-FFR were identical (0.82±0.10) with excellent correlation of individual values (r=0.96, p<0.001) and no difference in patient-reported symptoms. Four patients (2.6%) had discrepancies between the 2 drugs for the clinical decision-making cutoff of FFR≤0.80. Coronary flow responses to adenosine and regadenoson were similar (APV at maximal hyperemia 36cm/s for both, p=0.81). CONCLUSIONS Regadenoson single-bolus administration has comparable FFR, symptoms, and coronary flow augmentation when compared with standard intravenous adenosine infusion. With its greater ease of administration, regadenoson may be a more "user-friendly" option for invasive ischemic testing.
Collapse
|
22
|
Lee BK, Lim HS, Fearon WF, Yong AS, Yamada R, Tanaka S, Lee DP, Yeung AC, Tremmel JA. Invasive evaluation of patients with angina in the absence of obstructive coronary artery disease. Circulation 2015; 131:1054-60. [PMID: 25712205 DOI: 10.1161/circulationaha.114.012636] [Citation(s) in RCA: 243] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND More than 20% of patients presenting to the cardiac catheterization laboratory with angina have no angiographic evidence of coronary artery disease. Despite a "normal" angiogram, these patients often have persistent symptoms, recurrent hospitalizations, a poor functional status, and adverse cardiovascular outcomes, without a clear diagnosis. METHODS AND RESULTS In 139 patients with angina in the absence of obstructive coronary artery disease (no diameter stenosis >50%), endothelial function was assessed; the index of microcirculatory resistance, coronary flow reserve, and fractional flow reserve were measured; and intravascular ultrasound was performed. There were no complications. The average age was 54.0±11.4 years, and 107 (77%) were women. All patients had at least some evidence of atherosclerosis based on an intravascular ultrasound examination of the left anterior descending artery. Endothelial dysfunction (a decrease in luminal diameter of >20% after intracoronary acetylcholine) was present in 61 patients (44%). Microvascular impairment (an index of microcirculatory resistance ≥25) was present in 29 patients (21%). Seven patients (5%) had a fractional flow reserve ≤0.80. A myocardial bridge was present in 70 patients (58%). Overall, only 32 patients (23%) had no coronary explanation for their angina, with normal endothelial function, normal coronary physiological assessment, and no myocardial bridging. CONCLUSIONS The majority of patients with angina in the absence of obstructive coronary artery disease have occult coronary abnormalities. A comprehensive invasive assessment of these patients at the time of coronary angiography can be performed safely and provides important diagnostic information that may affect treatment and outcomes.
Collapse
Affiliation(s)
- Bong-Ki Lee
- From Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA (B.-K.L., H.-S.L., W.F.F., A.S.Y., R.Y., S.T., D.P.L., A.C.Y., J.A.T.); Division of Cardiology, Kangwon National University School of Medicine, Chuncheon, Republic of Korea (B.-K.L.); and Department of Cardiology, Ajou University School of Medicine, Suwon, Republic of Korea (H.-S.L.)
| | - Hong-Seok Lim
- From Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA (B.-K.L., H.-S.L., W.F.F., A.S.Y., R.Y., S.T., D.P.L., A.C.Y., J.A.T.); Division of Cardiology, Kangwon National University School of Medicine, Chuncheon, Republic of Korea (B.-K.L.); and Department of Cardiology, Ajou University School of Medicine, Suwon, Republic of Korea (H.-S.L.)
| | - William F Fearon
- From Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA (B.-K.L., H.-S.L., W.F.F., A.S.Y., R.Y., S.T., D.P.L., A.C.Y., J.A.T.); Division of Cardiology, Kangwon National University School of Medicine, Chuncheon, Republic of Korea (B.-K.L.); and Department of Cardiology, Ajou University School of Medicine, Suwon, Republic of Korea (H.-S.L.).
| | - Andy S Yong
- From Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA (B.-K.L., H.-S.L., W.F.F., A.S.Y., R.Y., S.T., D.P.L., A.C.Y., J.A.T.); Division of Cardiology, Kangwon National University School of Medicine, Chuncheon, Republic of Korea (B.-K.L.); and Department of Cardiology, Ajou University School of Medicine, Suwon, Republic of Korea (H.-S.L.)
| | - Ryotaro Yamada
- From Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA (B.-K.L., H.-S.L., W.F.F., A.S.Y., R.Y., S.T., D.P.L., A.C.Y., J.A.T.); Division of Cardiology, Kangwon National University School of Medicine, Chuncheon, Republic of Korea (B.-K.L.); and Department of Cardiology, Ajou University School of Medicine, Suwon, Republic of Korea (H.-S.L.)
| | - Shigemitsu Tanaka
- From Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA (B.-K.L., H.-S.L., W.F.F., A.S.Y., R.Y., S.T., D.P.L., A.C.Y., J.A.T.); Division of Cardiology, Kangwon National University School of Medicine, Chuncheon, Republic of Korea (B.-K.L.); and Department of Cardiology, Ajou University School of Medicine, Suwon, Republic of Korea (H.-S.L.)
| | - David P Lee
- From Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA (B.-K.L., H.-S.L., W.F.F., A.S.Y., R.Y., S.T., D.P.L., A.C.Y., J.A.T.); Division of Cardiology, Kangwon National University School of Medicine, Chuncheon, Republic of Korea (B.-K.L.); and Department of Cardiology, Ajou University School of Medicine, Suwon, Republic of Korea (H.-S.L.)
| | - Alan C Yeung
- From Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA (B.-K.L., H.-S.L., W.F.F., A.S.Y., R.Y., S.T., D.P.L., A.C.Y., J.A.T.); Division of Cardiology, Kangwon National University School of Medicine, Chuncheon, Republic of Korea (B.-K.L.); and Department of Cardiology, Ajou University School of Medicine, Suwon, Republic of Korea (H.-S.L.)
| | - Jennifer A Tremmel
- From Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA (B.-K.L., H.-S.L., W.F.F., A.S.Y., R.Y., S.T., D.P.L., A.C.Y., J.A.T.); Division of Cardiology, Kangwon National University School of Medicine, Chuncheon, Republic of Korea (B.-K.L.); and Department of Cardiology, Ajou University School of Medicine, Suwon, Republic of Korea (H.-S.L.)
| |
Collapse
|
23
|
Arbab-Zadeh A. Fractional flow reserve-guided percutaneous coronary intervention is not a valid concept. Circulation 2014; 129:1871-8; discussion 1878. [PMID: 24799503 DOI: 10.1161/circulationaha.113.003583] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Armin Arbab-Zadeh
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD
| |
Collapse
|
24
|
Kim MC, Jeong MH, Kim SH, Hong YJ, Kim JH, Ahn Y. Current Status of Coronary Intervention in Patients with ST-Segment Elevation Myocardial Infarction and Multivessel Coronary Artery Disease. Korean Circ J 2014; 44:131-8. [PMID: 24876852 PMCID: PMC4037633 DOI: 10.4070/kcj.2014.44.3.131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Primary percutaneous coronary intervention (PCI) is a standard interventional treatment modality for ST-segment elevation myocardial infarction (STEMI). Diagnostic coronary angiogram during PCI reveals multivessel coronary artery disease in about half of patients with STEMI, and it is difficult to make decision on the extent of intervention in these patients. Although revascularization for the infarct-related artery only is still effective for STEMI patients, several studies have reported the efficacy of multivessel revascularization during primary PCI, as well as in a staged PCI procedure. Clinicians should consider clinical aspects such as initial cardiogenic shock and myocardial viability when performing primary multivessel intervention, including the risks and benefits of multivessel revascularization in patients undergoing primary PCI. This review describes the current status of performing multivessel PCI in patients with STEMI and proposes an optimal revascularization strategy based on the previous literature.
Collapse
Affiliation(s)
- Min Chul Kim
- Department of Cardiovascular Medicine, Heart Center, Chonnam National University Hospital, Gwangju, Korea
| | - Myung Ho Jeong
- Department of Cardiovascular Medicine, Heart Center, Chonnam National University Hospital, Gwangju, Korea
| | - Sang Hyung Kim
- Department of Cardiovascular Medicine, Heart Center, Chonnam National University Hospital, Gwangju, Korea
| | - Young Joon Hong
- Department of Cardiovascular Medicine, Heart Center, Chonnam National University Hospital, Gwangju, Korea
| | - Ju Han Kim
- Department of Cardiovascular Medicine, Heart Center, Chonnam National University Hospital, Gwangju, Korea
| | - Youngkeun Ahn
- Department of Cardiovascular Medicine, Heart Center, Chonnam National University Hospital, Gwangju, Korea
| |
Collapse
|
25
|
Nijjer SS, Sen S, Petraco R, Sachdeva R, Cuculi F, Escaned J, Broyd C, Foin N, Hadjiloizou N, Foale RA, Malik I, Mikhail GW, Sethi AS, Al-Bustami M, Kaprielian RR, Khan MA, Baker CS, Bellamy MF, Hughes AD, Mayet J, Kharbanda RK, Di Mario C, Davies JE. Improvement in coronary haemodynamics after percutaneous coronary intervention: assessment using instantaneous wave-free ratio. Heart 2013; 99:1740-8. [PMID: 24047640 PMCID: PMC3841762 DOI: 10.1136/heartjnl-2013-304387] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Objective To determine whether the instantaneous wave-free ratio (iFR) can detect improvement in stenosis significance after percutaneous coronary intervention (PCI) and compare this with fractional flow reserve (FFR) and whole cycle Pd/Pa. Design A prospective observational study was undertaken in elective patients scheduled for PCI with FFR ≤0.80. Intracoronary pressures were measured at rest and during adenosine-mediated vasodilatation, before and after PCI. iFR, Pd/Pa and FFR values were calculated using the validated fully automated algorithms. Setting Coronary catheter laboratories in two UK centres and one in the USA. Patients 120 coronary stenoses in 112 patients were assessed. The mean age was 63±10 years, while 84% were male; 39% smokers; 33% with diabetes. Mean diameter stenosis was 68±16% by quantitative coronary angiography. Results Pre-PCI, mean FFR was 0.66±0.14, mean iFR was 0.75±0.21 and mean Pd/Pa 0.83±0.16. PCI increased all indices significantly (FFR 0.89±0.07, p<0.001; iFR 0.94±0.05, p<0.001; Pd/Pa 0.96±0.04, p<0.001). The change in iFR after intervention (0.20±0.21) was similar to ΔFFR 0.22±0.15 (p=0.25). ΔFFR and ΔiFR were significantly larger than resting ΔPd/Pa (0.13±0.16, both p<0.001). Similar incremental changes occurred in patients with a higher prevalence of risk factors for microcirculatory disease such as diabetes and hypertension. Conclusions iFR and FFR detect the changes in coronary haemodynamics elicited by PCI. FFR and iFR have a significantly larger dynamic range than resting Pd/Pa. iFR might be used to objectively document improvement in coronary haemodynamics following PCI in a similar manner to FFR.
Collapse
|
26
|
Al-Hassan D, Leipsic J. Noninvasive fractional flow reserve derived from coronary computed tomography angiography: integrated anatomical and functional assessment. Future Cardiol 2013; 9:243-51. [PMID: 23463976 DOI: 10.2217/fca.13.2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Coronary computed tomographic angiography (CCTA) provides anatomic detail of lumen stenosis and information on plaque burden, plaque extent and plaque characteristics. CCTA does not, however, provide insight into the hemodynamic significance of a stenosis, which is essential to allow appropriate revascularization decision-making. This could reduce downstream invasive coronary angiography and nonbeneficial coronary revascularization, particularly with intermediate coronary stenosis. Invasive fractional flow reserve (FFR) is the gold standard for the determination of lesion-specific ischemia and the need for revascularization. Advances in computational technology now permit calculation of FFR using resting CCTA image data, without the need for additional radiation or medication. Early data demonstrate improved accuracy and a discriminatory ability of FFR computed tomography to identify ischemia-producing lesions compared with CCTA alone. This new, combined anatomic-functional assessment has the potential to simplify the noninvasive diagnosis of coronary artery disease with a single study to identify patients with ischemia-causing stenosis who may benefit from revascularization.
Collapse
Affiliation(s)
- Donya Al-Hassan
- Department of Diagnostic Radiology, King Fahd Military Medical Complex, Dhahran 31932, Kingdom of Saudi Arabia
| | | |
Collapse
|
27
|
Petraco R, Park JJ, Sen S, Nijjer SS, Malik IS, Echavarría-Pinto M, Asrress KN, Nam CW, Macías E, Foale RA, Sethi A, Mikhail GW, Kaprielian R, Baker CS, Lefroy D, Bellamy M, Al-Bustami M, Khan MA, Gonzalo N, Hughes AD, Francis DP, Mayet J, Di Mario C, Redwood S, Escaned J, Koo BK, Davies JE. Hybrid iFR-FFR decision-making strategy: implications for enhancing universal adoption of physiology-guided coronary revascularisation. EUROINTERVENTION 2013; 8:1157-65. [PMID: 23256988 DOI: 10.4244/eijv8i10a179] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
AIMS Adoption of fractional flow reserve (FFR) remains low (6-8%), partly because of the time, cost and potential inconvenience associated with vasodilator administration. The instantaneous wave-Free Ratio (iFR) is a pressure-only index of stenosis severity calculated without vasodilator drugs. Before outcome trials test iFR as a sole guide to revascularisation, we evaluate the merits of a hybrid iFR-FFR decision-making strategy for universal physiological assessment. METHODS AND RESULTS Coronary pressure traces from 577 stenoses were analysed. iFR was calculated as the ratio between Pd and Pa in the resting diastolic wave-free window. A hybrid iFR-FFR strategy was evaluated, by allowing iFR to defer some stenoses (where negative predictive value is high) and treat others (where positive predictive value is high), with adenosine being given only to patients with iFR in between those values. For the most recent fixed FFR cut-off (0.8), an iFR of <0.86 could be used to confirm treatment (PPV of 92%), whilst an iFR value of >0.93 could be used to defer revascularisation (NPV of 91%). Limiting vasodilator drugs to cases with iFR values between 0.86 to 0.93 would obviate the need for vasodilator drugs in 57% of patients, whilst maintaining 95% agreement with an FFR-only strategy. If the 0.75-0.8 FFR grey zone is accounted for, vasodilator drug requirement would decrease by 76%. CONCLUSION A hybrid iFR-FFR decision-making strategy for revascularisation could increase adoption of physiology-guided PCI, by more than halving the need for vasodilator administration, whilst maintaining high classification agreement with an FFR-only strategy.
Collapse
Affiliation(s)
- Ricardo Petraco
- International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London and Imperial College Healthcare NHS Trust, London, United Kingdom.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Prasad A, Zareh M, Doherty R, Gopal A, Vora H, Somma K, Mehra A, Clavijo LC, Matthews RV, Shavelle DM. Use of regadenoson for measurement of fractional flow reserve. Catheter Cardiovasc Interv 2013; 83:369-74. [PMID: 23765847 DOI: 10.1002/ccd.25055] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 05/13/2013] [Accepted: 06/01/2013] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To compare the use of regadenoson to adenosine for measurement of fractional flow reserve (FFR). BACKGROUND FFR is an accepted method to assess the functional significance of intermediate coronary artery stenoses and uses adenosine to induce maximal hyperemia. The use of the selective A2a receptor agonist regadenoson for FFR is not established. METHODS Fifty-seven patients undergoing clinically indicated FFR assessment of intermediate coronary stenoses were included. For the initial assessment of FFR, hyperemia was achieved by a standard intravenous adenosine infusion (140 mcg/kg/min). After a washout period of 10 min, FFR was reassessed using regadenoson as a single 0.4 mg intravenous bolus. FFR measurements were recorded at baseline and following maximal hyperemia with both agents. RESULTS Mean age was 57 ± 8 years and 47 were male. Sixty coronary lesions were evaluated and were located in the left anterior descending in 34, the left circumflex in 9, right coronary in 15, and left main coronary artery in 2. Mean ( ± SD) FFR following adenosine and regadenoson was 0.79 ( ± 0.09) and 0.79 (±0.09), respectively, P = NS. Time to FFR nadir was shorter with regadenoson compared to adenosine, 36.6 ± 24 versus 66 ± 0.19 sec, P < 0.0001, respectively. No patients experienced any significant side effects related to regadenoson. CONCLUSIONS Regadenoson is a viable alternative to intravenous adenosine for achieving maximal hyperemia during FFR assessment. Compared to adenosine, regadenoson has a similar hemodynamic response, achieves more rapid hyperemia, is easier to use, and has an excellent side-effect profile.
Collapse
Affiliation(s)
- Aditya Prasad
- Division of Cardiovascular Medicine, University of Southern California, Los Angeles, California
| | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
López-Palop R, Carrillo P, Frutos A, Cordero A, Agudo P, Mashlab S, Bertomeu-Martínez V. Comparison of effectiveness of high-dose intracoronary adenosine versus intravenous administration on the assessment of fractional flow reserve in patients with coronary heart disease. Am J Cardiol 2013; 111:1277-83. [PMID: 23415635 DOI: 10.1016/j.amjcard.2013.01.270] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2012] [Revised: 01/02/2013] [Accepted: 01/02/2013] [Indexed: 01/10/2023]
Abstract
Intravenous adenosine is considered the drug of choice to obtain maximum hyperemia in the measurement of the fractional flow reserve (FFR). However, comparative studies performed between intravenous and intracoronary administration have not used high doses of intracoronary adenosine. The present study compared the efficacy and safety of high doses of intracoronary adenosine to intravenous administration when calculating the FFR. Intracoronary bolus doses of 60, 180, 300, and 600 μg adenosine were compared to an intravenous administration of 140 μg/kg/min, 200 μg/kg/min, and 140 μg/kg/min plus an intracoronary bolus of 120 μg. All the cases were performed using the radial approach. FFR was assessed in 102 patients with 108 intermediate lesions by an intracoronary pressure wire. The intracoronary dose of 60 μg was associated with a significantly greater FFR compared to the intravenous infusion (0.02 ± 0.03, p = 0.001). The intracoronary doses of 300 (-0.01 ± 0.00; p = 0.006) and 600 μg (-0.02 ± 0.00; p <0.0005) were significantly associated with a smaller FFR compared to the intravenous infusion. An intracoronary dose of 600 μg revealed a significantly greater percentage of lesions with an FFR <0.80 compared to intravenous infusion at 140 μg/kg/min (37.6 vs 31.5%; p <0.05) and 200 μg/kg/min (37.6 vs 32.4%; p <0.05) and compared to intracoronary doses of 60 (26.9%) and 180 μg (31.5%). In conclusion, an intracoronary bolus dose >300 μg can be equal to or more effective than an intravenous infusion of adenosine in achieving maximum hyperemia when calculating the FFR. Its use could simplify these procedures without having an effect on safety.
Collapse
Affiliation(s)
- Ramón López-Palop
- Department of Cardiology, Hospital Universitario San Juan de Alicante, Alicante, Spain.
| | | | | | | | | | | | | |
Collapse
|
30
|
Hakeem A, Mouhamad A, Leesar MA. Fractional flow reserve: a new paradigm for diagnosis and management of coronary artery disease. Interv Cardiol 2012. [DOI: 10.2217/ica.11.82] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
31
|
Muller O, Mangiacapra F, Ntalianis A, Verhamme KM, Trana C, Hamilos M, Bartunek J, Vanderheyden M, Wyffels E, Heyndrickx GR, van Rooij FJ, Witteman JC, Hofman A, Wijns W, Barbato E, De Bruyne B. Long-Term Follow-Up After Fractional Flow Reserve–Guided Treatment Strategy in Patients With an Isolated Proximal Left Anterior Descending Coronary Artery Stenosis. JACC Cardiovasc Interv 2011; 4:1175-82. [DOI: 10.1016/j.jcin.2011.09.007] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Revised: 09/07/2011] [Accepted: 09/09/2011] [Indexed: 10/15/2022]
|
32
|
Abstract
The adoption of invasive coronary physiologic lesion assessment before percutaneous coronary intervention has become routine in many catheterization laboratories. In the last decade, numerous studies have demonstrated favorable outcomes for revascularization decisions based on in-lab coronary physiology in many patients. The use of coronary physiology in the laboratory has been identified as a class IIa recommendation for patients in whom the clinical presentation and supporting data are too inconclusive to make an objective decision regarding treatment. This article reviews pertinent concepts and studies of the more complex applications of translesional pressure measurements for optimal patient outcomes.
Collapse
Affiliation(s)
- Morton J Kern
- Division of Cardiology, Long Beach Veterans Administration Hospital, University of California, 101 The City Drive, Orange, Irvine, CA 92866, USA.
| |
Collapse
|
33
|
Use of Coronary Physiology in the Catheterization Laboratory to Guide Treatment in Patients With Coronary Artery Disease. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2010; 13:35-45. [DOI: 10.1007/s11936-010-0102-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
|